Clinical features and therapeutic strategies for Talaromyces Marneffei pneumonia in kidney transplant recipients

Objective To analyze the clinical characteristics, diagnosis, treatment, and prognosis of Talaromyces marneffei pneumonia (TMP) in kidney transplant recipients, providing clinical evidence. Methods A retrospective analysis was conducted among 8 HIV-negative patients who underwent deceased donor kidney transplantation and were subsequently diagnosed with TMP at the Second Xiangya Hospital of Central South University from January 2015 to January 2025. Clinical data pertinent to the study, including demographic features, diagnostic modalities, therapeutic regimens, and prognosis, were systematically collected and analyzed. Results Of the 8 patients (7 males, 1 female; mean age 45.12 ± 9.03 years), the median time from transplantation to TMP onset was 356.5 days(IQR,302.75-771.75). All presented with fever (2 accompanied by cough), and chest CT showed diverse opacities. Metagenomic next-generation sequencing (mNGS) was the primary diagnostic tool, detecting Talaromyces marneffei in 7 cases (87.5% detection rate) with an average diagnosis time of 5 ± 2.56 days, while traditional culture only confirmed 3 cases. Amphotericin B was administered as the core induction therapy, followed by maintenance therapy after approximately 2 weeks, combined with individualized oral azole drugs tailored to each patient’s condition. All patients achieved clinical cure with no severe adverse reactions. The dosage of immunosuppressants was adjusted during anti-TMP treatment. Conclusion Kidney transplant recipients on long-term immunosuppressants are at significant risk of TMP. Combining mNGS with traditional culture enables early diagnosis, while amphotericin B and itraconazole are core treatments. Monitoring and adjusting immunosuppressant concentrations during azole therapy is critical for efficacy and long-term graft survival.