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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Detalles Bibliográficos
Autores: López Medrano, Francisco, Fernández Ruiz, Mario, Silva, José Tiago, Carver, Peggy L., Delden, Christian van, Merino Cabrera, Esperanza, Pérez Sáez, María José, Montero, María Milagro, Coussement, Julien, Abreu Mazzolin, Milene de, Cervera, Carlos, Santos, Lidia, Sabé, Nuria, Scemla, Anne, Cordero, Elisa, Cruzado Vega, Leónidas, Martín Moreno, Paloma Leticia, Len, Óscar, Rudas, Eddison, Ponce de León, Alfredo, Arriola, Mariano, Lauzurica, Ricardo, David, Miruna D., González Rico, Claudia, Henríquez Palop, Fernando, Fortún, Jesús, Nucci, Marcio, Manuel, Oriol, Paño Pardo, José Ramón, Montejo, Miguel, Vena, Antonio, Sánchez Sobrino, Beatriz, Mazuecos, María A., Pascual, Julio (Pascual Santos), Horcajada Gallego, Juan Pablo, Lecompte, Thanh, Moreno Camacho, Ma. Asunción, Carratalà, Jordi, Blanes, Marino, Perelló Carrascosa, Manuel, Muñoz, Patricia, Andrés, Amado, Aguado, José María, 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)
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2018
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/134999
Acceso en línea:https://hdl.handle.net/2445/134999
Access Level:acceso abierto
Palabra clave:Trasplantament renal
Factors de risc en les malalties
Malalties de l'aparell respiratori
Aspergil·losi
Kidney transplantation
Risk factors in diseases
Respiratory diseases
Aspergillosis
Descripción
Sumario: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.

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