Publicaciones científicas
Risk factors associated with early invasive pulmonary aspergillosis in kidney transplant recipients: results from a multinational matched case-control study
López-Medrano F (1), Silva JT (1), Fernández-Ruiz M (1), Carver PL (2), van Delden C (3), Merino E (4), Pérez-Saez MJ (5), Montero M (6), Coussement J (7), de Abreu Mazzolin M (8), Cervera C (9), Santos L (10), Sabé N (11), Scemla A (12), Cordero E (13), Cruzado-Vega L (14), Martín PL (15), Len Ó (16), Rudas E (17), Ponce de León A (18), Arriola M (19), Lazurica R (20), David M (21), González-Rico C (22), Henríquez-Palop F (23), Fortún J (24), Nucci M (25), Manuel O (26), Paño-Pardo JR (27), Montejo M (28), Muñoz P (29), Sánchez-Sobrino B (30), Mazuecos A (31), Pascual J (5), Horcajada JP (6), Lecompte T (3), Lumbreras C (1), Moreno A (9), Carratalà J (11), Blanes M (32), Hernández D (17), Hernández-Méndez EA (18), Fariñas MD (22), Perelló-Carrascosa M (33), Morales JM (34), Andrés A (34), Aguado JM (1); Spanish Network for Research in Infectious Diseases REIPI); Group for the Study of Infection in Transplant Recipients (GESITRA); Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); Study Group for Infections in Compromised Hosts (ESGICH); European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Swiss Transplant Cohort Study (STCS).
RESUMEN
Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) have been poorly explored. We performed a multinational case-control study that included 51 KT recipients diagnosed with early (first 180 post-transplant days) IPA in 19 institutions between 2000 and 2013.
Controls recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8% and 25.0% of survivors experienced graft loss. Pre-transplant diagnosis of chronic pulmonary obstructive disease (COPD) (odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; P-value = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; P-value = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peri-transplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; P-value = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; P-value = 0.003) within the three months prior to the diagnosis of IPA acted as risk factors during the subsequent period.
In conclusion, pre-transplant COPD, impaired graft function and the occurrence of serious post-transplant infections may be useful to identify KT recipients at the highest risk for early IPA. Futures studies should explore the potential benefit of anti-mold prophylaxis in this group.
CITA DEL ARTÍCULO Am J Transplant. 2016 Jul;16(7):2148-57.
doi: 10.1111/ajt.13735. Epub 2016 Mar 10.
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