Clinical Characteristics, Pharmacotherapy, and Outcomes of Mucormycosis in Kidney Transplant Recipients Diagnosed with COVID-19: A Cross-Sectional Study at a Referral Center in Iran

Abstract

Background: Mucormycosis is a rare fungal infection that affects immunocompromised individuals, with key
predisposing factors including diabetes and organ transplantation. The COVID-19 pandemic led to a global
increase in mucormycosis cases, but data on kidney transplant recipients (KTRs) remain limited.
Objective: This study evaluates the epidemiology and outcomes of mucormycosis in KTRs at an Iranian referral
center.
Methods: This retrospective cohort study examined the clinical features, risk factors, treatment approaches,
and outcomes of mucormycosis in KTRs with prior COVID-19 infection (case group) compared to KTRs with
COVID-19 but without mucormycosis (control group). The study was conducted from July 2023 to August 2024
at the largest organ transplant center in Shiraz, southern Iran.
Results: The study comprised 119 participants (14 mucormycosis cases, 105 controls). Cases predominantly
involved males (64.3%) aged 40–60 years, with 64.3% being overweight/obese and high rates of hypertension (50%) and diabetes (21.4%). Most mucormycosis diagnoses (64.3%) occurred within five years postkidney transplantation, with a median baseline eGFR of 27.5 ml/min/1.73 m². Controls had a similar male predominance (67.7%), but a lower prevalence of overweight/obesity (10.5%), and a 48.1% history of COVID-19
within the past year. COVID-19 treatments included corticosteroids (78.6%) and remdesivir (39.1%). Orbital
mucormycosis (45.4%) predominated, with spring being the peak diagnostic season. All cases underwent CT
imaging and received antifungal treatment. Univariate analysis revealed no significant risk factors for the development of mucormycosis. Hospital mortality was 35.8% in the case group versus 18% in the control group,
and the case group had a markedly longer hospital stay (24 days vs. 8 days).
Conclusion: Mucormycosis predominantly affected males aged 40-60 with high rates of comorbidities and corticosteroid use. This study is one of the few to examine KTRs with COVID-19–associated mucormycosis in Iran.
Most diagnoses occurred within five years post-transplantation, with orbital mucormycosis being common. No
independent risk factors for the development of mucormycosis were identified. Further research is needed to
understand risk factors and improve management for KTRs.