{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:23:18Z","timestamp":1790774598171,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,6,17]],"date-time":"2023-06-17T00:00:00Z","timestamp":1686960000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Invasive fungal infections (IFI), are estimated to occur in 2%\u201314% of kidney transplant recipients (KTRs) in the current era of immune suppression and are associated with high mortality rates. We hypothesized that hypoalbuminemia in KTRs is a risk factor for IFI and would be associated with poor outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this study, using data from a prospective cohort registry, we describe the frequency of IFI due to <jats:italic>Blastomycosis<\/jats:italic>, <jats:italic>Coccidioidomycosis<\/jats:italic>, <jats:italic>Histoplasmosis<\/jats:italic>, <jats:italic>Aspergillosis<\/jats:italic>, and <jats:italic>Cryptococcus<\/jats:italic> in KTRs with serum albumin levels measured 3\u20136\u00a0months before diagnosis. Controls were selected based on incidence density sampling. KTRs were divided into three groups based on the pre\u2010IFI serum albumin level: normal (\u22654\u00a0g\/dL), mild (3\u20134\u00a0g\/dL), or severe (&lt;3\u00a0g\/dL) hypoalbuminemia. Outcomes of interest were uncensored graft failure after IFI and overall mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 113 KTRs with IFI were compared with 348 controls. The incidence rate of IFI among individuals with normal, mild, and severe hypoalbuminemia was 3.6, 8.7, and 29.3 per 100 person\u2010years, respectively. After adjustment for multiple variables, the trend for risk of uncensored graft failure following IFI was greater in KTRS with mild (HR\u00a0=\u00a02.1; 95% CI, .75\u20136.1) and severe (HR\u00a0=\u00a04.47; 95% CI, 1.56\u201312.8) hypoalbuminemia (<jats:italic>P<\/jats:italic>\u2010trend\u00a0&lt;\u00a0.001) compared to those with normal serum albumin. Similarly, mortality was higher in severe hypoalbuminemia (HR\u00a0=\u00a01.9; 95% CI, .67\u20135.6) compared to normal serum albumin (<jats:italic>P<\/jats:italic>\u2010trend\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hypoalbuminemia precedes the diagnosis of IFI in KTRs, and is associated with poor outcomes following IFI. Hypoalbuminemia may be a useful predictor of IFI in KTRs and could be incorporated into screening algorithms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15052","type":"journal-article","created":{"date-parts":[[2023,6,17]],"date-time":"2023-06-17T12:15:25Z","timestamp":1687004125000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Hypoalbuminemia is a risk factor for invasive fungal infections and poor outcomes in infected kidney transplant recipients"],"prefix":"10.1111","volume":"37","author":[{"given":"Angelie","family":"Santos","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-9727","authenticated-orcid":false,"given":"Margaret R.","family":"Jorgenson","sequence":"additional","affiliation":[{"name":"Department of Pharmacy University of Wisconsin Hospital and Clinics Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauzia","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aniruddha","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Ann","family":"Misch","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin 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