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

Objectives: To assess the risk factors for 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...

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Detalhes bibliográficos
Autores: Lopez-Medrano, F., Fernandez-Ruiz, M., Silva, J. T., Carver, P. L., van Delden, C., Merino, E., Perez-Saez, M. J., Montero, M., Coussement, J., de Abreu Mazzolin, M. [UNIFESP], Cervera, C., Santos, L., Sabe, N., Scemla, A., Cordero, E., Cruzado-Vega, L., Martin-Moreno, P. L., Len, O., Rudas, E., Ponce de Leon, A., Arriola, M., Lauzurica, R., David, M. D., Gonzalez-Rico, C., Henriquez-Palop, F., Fortun, J., Nucci, M., Manuel, O., Pano-Pardo, R., Montejo, M., Vena, A., Sanchez-Sobrino, B., Mazuecos, A., Pascual, J., Horcajada, J. P., Lecompte, T., Moreno, A., Carratala, J., Blanes, M., Hernandez, D., Hernandez-Mendez, E. A., Farinas, M. C., Perello-Carrascosa, M., Munoz, P., Andres, A., Aguado, J. M.
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:Brasil
Recursos:Universidade Federal de São Paulo (UNIFESP)
Repositorio:Repositório Institucional da UNIFESP
Idioma:inglés
OAI Identifier:oai:repositorio.unifesp.br:11600/54200
Acesso em linha:http://dx.doi.org/10.1016/j.cmi.2017.06.016
https://repositorio.unifesp.br/handle/11600/54200
Access Level:acceso abierto
Palavra-chave:Case-control study
Kidney transplantation
Late invasive pulmonary aspergillosis
Risk factors
Descrição
Resumo:Objectives: To assess the risk factors for 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 centre 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 centres (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 five cases occurred more than 10 years after transplantation. Overall mortality among cases was 47.5% (29/61). Compared with controls, cases were significantly older (p 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (p 0.001) and a diagnosis of bloodstream infection (p 0.016) and IRE (p < 0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (OR 19.26 95% CI 2.07-179.46 p 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. (c) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

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