Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients
F López-Medrano 1 , M Fernández-Ruiz 2 , J T Silva 2 , P L Carver 3 , C van Delden 4 , E Merino 5 , M J Pérez-Saez 6 , M Montero 7 , J Coussement 8 , M de Abreu Mazzolin 9 , C Cervera 10 , L Santos 11 , N Sabé 12 , A Scemla 13 , E Cordero 14 , L Cruzado-Vega 15 , P L Martín-Moreno 16 , Ó Len 17 , E Rudas 18 , A P de León 19 , M Arriola 20 , R Lauzurica 21 , M David 22 , C González-Rico 23 , F Henríquez-Palop 24 , J Fortún 25 , M Nucci 26 , O Manuel 27 , J R Paño-Pardo 28 , M Montejo 29 , P Muñoz 30 , B Sánchez-Sobrino 31 , A Mazuecos 32 , J Pascual 6 , J P Horcajada 7 , T Lecompte 4 , A Moreno 10 , J Carratalà 12 , M Blanes 33 , D Hernández 18 , M C Fariñas 23 , A Andrés 34 , J M Aguado 2 , Spanish Network for Research in Infectious Diseases (REIPI), the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC), the Study Group for Infections in Compromised Hosts (ESGICH) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and the Swiss Transplant Cohort Study (STCS)
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%, respectively. Aspergillus fumigatus was the most commonly identified species. Six- and 12-week survival rates were 68.8% and 60.7%, respectively, 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.