{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:19:19Z","timestamp":1786123159011,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extrapulmonary invasive fungal infections (IFIs) in kidney transplant recipients (KTRs) are understudied, particularly in endemic, resource\u2010limited settings. This study evaluated the epidemiology, risk factors, and outcomes of extrapulmonary IFIs in KTRs in northern India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this nested case\u2010control study of 1649 KTRs (2007\u20132022), microbiologically proven extrapulmonary IFI cases were identified from microbiology and histopathology databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Extrapulmonary IFI occurred in 67 KTRs (4.1%). Cryptococcosis (46.3%) and candidiasis (20.9%) were the predominant infections. The central nervous system was the most common site (44.8%), followed by the bloodstream (22.4%). The mean age was 46.78 years, and 85.1% were males. The median time to infection was 55 months posttransplant, and 79.1% of infections occurred beyond 1 year posttransplant. Median estimated glomerular filtration rate (eGFR) was 43\u00a0mL\/min\/1.73\u00a0m\n                      <jats:sup>2<\/jats:sup>\n                      , and acute graft dysfunction was present in 49.3% cases. Comorbidities included diabetes (44.8%), chronic renal allograft injury (59.7%), acute rejection (38.8%), bacterial infection (26.9%), and cytomegalovirus disease (13.4%). Diabetes (OR 2.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.038) and methylprednisolone pulses for rejection (OR 3.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.025) were independently associated with IFI. Infection\u2010related mortality was 35.8%; disseminated infection (HR 3.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.020) and requirement for kidney replacement therapy (KRT) (HR 3.98,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.011) independently predicted death. Note that, 5\u2010 and 10\u2010year patient survival was significantly lower in cases than in controls (74.1% and 48.3% vs. 92.3% and 74.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.008), whereas death\u2010censored graft survival was comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Extrapulmonary IFIs are late\u2010onset and commonly present as cryptococcal meningitis or candidemia. Diabetes and methylprednisolone pulses increase infection risk, while dissemination and KRT requirement predict mortality.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid70218-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.70218","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T10:11:00Z","timestamp":1778753460000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology and Outcomes of Extrapulmonary Invasive Fungal Infections After Kidney Transplantation in Northern India"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2998-3505","authenticated-orcid":false,"family":"Abdullah","sequence":"first","affiliation":[{"name":"Department of Nephrology and Renal Transplantation Sanjay Gandhi Post Graduate Institute of Medical Sciences  Lucknow India"},{"name":"Department of Nephrology Institute of Medical Sciences Banaras Hindu University  Varanasi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9994-2326","authenticated-orcid":false,"given":"Anupma","family":"Kaul","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Renal Transplantation Sanjay Gandhi Post Graduate Institute of Medical Sciences  Lucknow 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