Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation. (February 2018)

• Record Type: Journal Article
• Authors: López-Medrano, F.; Fernández-Ruiz, M.; Silva, J.T.; Carver, P.L.; van Delden, C.; Merino, E.; Pérez-Saez, M.J.; Montero, M.; Coussement, J.; de Abreu Mazzolin, M.; Cervera, C.; Santos, L.; Sabé, N.; Scemla, A.; Cordero, E.; Cruzado-Vega, L.; Martín-Moreno, P.L.; Len, Ó.; Rudas, E.; Ponce de León, A.; Arriola, M.; Lauzurica, R.; David, M.D.; González-Rico, C.; Henríquez-Palop, F.; Fortún, J.; Nucci, M.; Manuel, O.; Paño-Pardo, J.R.; Montejo, M.; Vena, A.; Sánchez-Sobrino, B.; Mazuecos, A.; Pascual, J.; Horcajada, J.P.; Lecompte, T.; Moreno, A.; Carratalà, J.; Blanes, M.; Hernández, D.; Hernández-Méndez, E.A.; Fariñas, M.C.; Perelló-Carrascosa, M.; Muñoz, P.; Andrés, A.; Aguado, J.M.;
• Is Part Of: Clinical microbiology and infection. Volume 24:Number 2(2018)
• Page Start: 192
• Page End: 198
• Publication Date: 2018-02
• Subjects: Case-control study -- Kidney transplantation -- Late invasive pulmonary aspergillosis -- Risk factors; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2017.06.016
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: To assess the risk factors for development of late-onset invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT). Methods: We performed a multinational case-control study that retrospectively recruited 112 KT recipients diagnosed with IPA between 2000 and 2013. Controls were matched (1:1 ratio) by centre and date of transplantation. Immunosuppression-related events (IREs) included the occurrence of non-ventilator-associated pneumonia, tuberculosis, cytomegalovirus disease, and/or de novo malignancy. Results: We identified 61 cases of late (>180 days after transplantation) IPA from 24 participating centres (accounting for 54.5% (61/112) of all cases included in the overall study). Most diagnoses (54.1% (33/61)) were established within the first 36 post-transplant months, although five cases occurred more than 10 years after transplantation. Overall mortality among cases was 47.5% (29/61). Compared with controls, cases were significantly older (p 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (p 0.001) and a diagnosis of bloodstream infection (p 0.016) and IRE (p <0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (OR 19.26; 95% CI 2.07–179.46; p 0.009) was identified as an independent risk factor for late IPA. Conclusion: More than half of IPA cases after KT occur beyond the sixth month, with some of them presenting very late. Late IPA entails a poor prognosis. We identified some risk factors that could help the clinician to delimit the subgroup of KT recipients at the highest risk for late IPA.