Epidemiology, clinical manifestations, and outcome of mucormycosis in solid organ transplant recipients: a systematic review of reported cases

Abstract Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTR). We systematically reviewed 183 cases occurring in SOTR, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%) and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7% of cases reported within 100 days of transplantation and 20.6% occurring at least one year after transplant. The 90-day and 1-year mortality rates were 36.3% and 63.4%, respectively. Disseminated disease had the highest mortality at both time points (75% and 93%). Treatment with more than three immunosuppressive drugs showed a significant impact on 90-day mortality (OR 2.33, 95%CI 1.02-5.66; p=0.0493), as did a disseminated disease manifestation (OR 8.23, 95%, CI 2.20-36.71; p=0.0027) and the presence of diabetes (OR 2.35, 95%, CI 1.01-5.65; p=0.0497). Notably, prophylaxis was administered to twelve cases with amphotericin B. Further investigations are needed to validate these findings and to evaluate the potential implementation of prophylactic regimens in high-risk SOTR.