Scientific publications

Multinational retrospective case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

López-Medrano F (1), Fernández-Ruiz M (2), Silva JT (2), Carver PL (3), van Delden C (4), Merino E (5), Pérez-Saez MJ (6), Montero M (7), Coussement J (8), de Abreu Mazzolin M (9), Cervera C (10), Santos L (11), Sabé N (12), Scemla A (13), Cordero E (14), Cruzado-Vega L (15), Martín-Moreno PL (16), Len Ó (17), Rudas E (18), Ponce de León A (19), Arriola M (20), Lauzurica R (21), David MD (22), González-Rico C (23), Henríquez-Palop F (24), Fortún J (25), Nucci M (26), Manuel O (27), Paño-Pardo JR (28), Montejo M (29), Vena A (30), Sánchez-Sobrino B (31), Mazuecos A (32), Pascual J (6), Horcajada JP (7), Lecompte T (4), Moreno A (10), Carratalà J (12), Blanes M (33), Hernández D (18), Hernández-Méndez EA (19), Fariñas MC (23), Perelló-Carrascosa M (34), Muñoz P (35), Andrés A (36), Aguado JM (2); Spanish Network for Research in Infectious Diseases (REIPI); Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); Study Group for Infections in Compromised Hosts (ESGICH) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Swiss Transplant Cohort Study (STCS). (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) 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.
(3) University of Michigan College of Pharmacy, Department of Clinical Pharmacy, University of Michigan Health System, Ann Arbor, Michigan.
(4) Unit of Transplant Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland.
(5) Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain.
(6) Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
(7) Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
(8) Department of Nephrology, Dialysis and Kidney Transplantation, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
(9) Division of Nephology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil.
(10) Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain.
(11) Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and Universitary Centre, Coimbra, Portugal.
(12) Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
(13) 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.
(14) Department of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
(15) Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain.
(16) Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain.
(17) Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
(18) Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain.
(19) Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, Mexico.
(20) Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina.
(21) Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
(22) Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
(23) Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain.
(24) Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain.
(25) Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain.
(26) Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
(27) Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Switzerland.
(28) Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
(29) Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain.
(30) Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
(31) Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
(32) Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain.
(33) Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain.
(34) Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
(35) Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.
(36) 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.

Magazine: Clinical Microbiology and Infection

Date: Jun 23, 2017

Nephrology [SP]

OBJECTIVES:

To assess the risk factors for the 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 center 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 centers (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 5 cases occurred more than 10 years after transplantation.

Overall mortality among cases was 47.5% (29/61). Compared to controls, cases were significantly older (P-value = 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (P-value = 0.001) and a diagnosis of bloodstream infection (P-value = 0.016) and IRE (P-value <0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (odds ratio: 19.26; 95% confidence interval: 2.07 - 179.46; P-value = 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.

CITA DEL ARTÍCULO  Clin Microbiol Infect. 2017 Jun 23. pii: S1198-743X(17)30335-X. doi: 10.1016/j.cmi.2017.06.016

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