Publicações científicas

Clinical presentation and determinants of mortality of invasive pulmonary aspergillosis in kidney transplant recipients: a multinational cohort study

López-Medrano F (1), Fernández-Ruiz M (1), Silva JT (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-Moreno PL [ES] (15), Len Ó (16), Rudas E (17), Ponce de León A (18), Arriola M (19), Lauzurica 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), Moreno A (9), Carratalà J (11), Blanes M (32), Hernández D (17), Del Fariñas MC (22), Andrés A (33), Aguado JM (1).
(1) Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
(2) University of Michigan Health System, Ann Harbor, Michigan.
(3) Service of Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland.
(4) Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain.
(5) Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
(6) Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
(7) Department of Nephrology, Dialysis and Kidney Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
(8) Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil.
(9) Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain.
(10) Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
(11) Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
(12) Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France.
(13) Unit of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
(14) Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain.
(15) Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain.
(16) Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
(17) Department of Nephrology, , Hospital Universitario "Carlos Haya", Málaga, Spain.
(18) Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, México.
(19) Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina.
(20) Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
(21) Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
(22) Department of Infectious Diseases, University Hospital Marqués de Valdecilla, Santander, Spain.
(23) Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain.
(24) Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain.
(25) Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
(26) Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Switzerland.
(27) Department of Internal Medicine, , Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
(28) Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain.
(29) Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
(30) Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
(31) Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain.
(32) Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain.
(33) Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain. 

Revisão:American Journal of Transplantation

Data: 23/Abr/2016

Nefrologia [ES]

RESUMO

The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%)

IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases.

Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%. Aspergillus fumigatus was the most commonly identified species. Six- and 12-weeks survival rates were 68.8% and 60.7%, and 22.1% of survivors experienced graft loss.

Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; P-value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; P-value = 0.017) were independent predictors for 6-week all-cause mortality, whereas the initial use of a voriconazole-based regimen showed a protective effect (HR: 0.34; P-value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome.

In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.

CITAÇÃO DO ARTIGO  Am J Transplant. 2016 Apr 23. doi: 10.1111/ajt.13837

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