Publicaciones científicas
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).
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. 2018 Feb;24(2):192-198.
doi: 10.1016/j.cmi.2017.06.016. Epub 2017 Jun 23.
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