ESOPHAGEAL CANDIDIASIS AFTER RENAL-TRANSPLANTATION - COMPARATIVE-STUDY IN PATIENTS ON DIFFERENT IMMUNOSUPPRESSIVE PROTOCOLS

Objectives: The incidence of esophageal candidiasis (EC) in renal allo graft recipients has not been well documented. The present study was d one to determine the incidence of EC in renal allograft recipients rec eiving different forms of immunosuppressive therapy and to identify pa tients at a high risk of developing Candida esophagitis. Methods: We c onducted a retrospective study of 265 live related renal allograft rec ipients and compared three groups: patients given azathioprine and pre dnisolone (group I), those given cyclosporine, azathioprine, and predn isolone (group II), and those given cyclosporine and prednisolone (gro up III). EC was diagnosed by esophagogastroduodenoscopy. Results: The overall incidence of EC was 10.5%. Group II patients had a significant ly higher incidence (28.6%) than those in group I (10.4%) and group II I (3.8%). EC was noted earlier in patients in groups II and III, who w ere on higher doses of steroids than group I patients. Dysphagia (57.1 %) was the most common presenting symptom of EC, but 21.4% of patients were asymptomatic. Oral thrush was present in 42.9%. The entire esoph ageal mucosa was affected in six (46.1%) patients in group II and one (20%) in group III. No correlation was found between fungal serology o r daily dose of steroids and extent of esophageal involvement. Treatme nt included nystatin in seven, nystatin and ketoconazole in 10, ketoco nazole alone in eight, amphotericin B in one, and ketoconazole and amp hotericin B in two episodes. Treatment failure occurred in seven (25%) . Three patients died of disseminated candidiasis. Serology and biopsy were poor predictors of dissemination. Conclusions: In this retrospec tive study of renal allograft recipients, patients on triple drug immu nosuppression, diabetics, and those with myelosuppression had an incre ased risk of developing EC. This high incidence calls for prophylactic use of antifungal agents in selected renal transplant recipients.