Journal article
Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study.
- Neofytos D Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Chatzis O Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Nasioudis D Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Boely Janke E Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Doco Lecompte T Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- Garzoni C Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
- Berger C Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zürich, Zürich, Switzerland.
- Cussini A Department of Infectious Diseases, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
- Boggian K Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
- Khanna N Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland.
- Manuel O Service of Infectious Diseases and Transplantation Center, University Hospital of Lausanne, Lausanne, Switzerland.
- Mueller NJ Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland.
- van Delden C Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland.
- 2018-04-19
Published in:
- Transplant infectious disease : an official journal of the Transplantation Society. - 2018
epidemiology
invasive aspergillosis
solid organ transplant recipients
Adolescent
Adult
Aged
Aspergillus
Biomarkers
Case-Control Studies
Female
Follow-Up Studies
Graft Rejection
Humans
Immunosuppression
Incidence
Invasive Pulmonary Aspergillosis
Lung
Male
Middle Aged
Organ Transplantation
Prospective Studies
Radiography
Risk Factors
Switzerland
Transplant Recipients
Young Adult
English
BACKGROUND
There is lack of recent multicenter epidemiological data on invasive aspergillosis (IA) among solid organ transplant recipient (SOTr) in the mold-acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOTr using the Swiss Transplant Cohort Study.
METHODS
All consecutive SOTr with proven or probable IA between 01.05.2008 and 31.12.2014 were included. A case-control study to identify IA predictors was performed: 1-case was matched with 3-controls based on SOT type, transplant center, and time post-SOT.
RESULTS
Among 2868 SOTr, 70 (2.4%) patients were diagnosed with proven (N: 30/70, 42.9%) or probable (N: 40/70, 57.1%) IA. The incidence of IA was 8.3%, 7.1%, 2.6%, 1.3%, and 1.2% in lung, heart, combined, kidney, and liver transplant recipients, respectively, Galactomannan immunoassay was positive in 1/3 of patients tested. Only 33/63 (52.4%) of patients presented with typical pulmonary radiographic findings. Predictors of IA included: renal insufficiency, re-operation, and bacterial and viral infections. 12-week mortality was higher in liver (85.7%, 6/7) compared to other (15.9%, 10/63; P < .001) SOTr.
CONCLUSIONS
Invasive aspergillosis remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Although overall mortality has decreased in SOTr, it remains high in liver SOTr.
There is lack of recent multicenter epidemiological data on invasive aspergillosis (IA) among solid organ transplant recipient (SOTr) in the mold-acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOTr using the Swiss Transplant Cohort Study.
METHODS
All consecutive SOTr with proven or probable IA between 01.05.2008 and 31.12.2014 were included. A case-control study to identify IA predictors was performed: 1-case was matched with 3-controls based on SOT type, transplant center, and time post-SOT.
RESULTS
Among 2868 SOTr, 70 (2.4%) patients were diagnosed with proven (N: 30/70, 42.9%) or probable (N: 40/70, 57.1%) IA. The incidence of IA was 8.3%, 7.1%, 2.6%, 1.3%, and 1.2% in lung, heart, combined, kidney, and liver transplant recipients, respectively, Galactomannan immunoassay was positive in 1/3 of patients tested. Only 33/63 (52.4%) of patients presented with typical pulmonary radiographic findings. Predictors of IA included: renal insufficiency, re-operation, and bacterial and viral infections. 12-week mortality was higher in liver (85.7%, 6/7) compared to other (15.9%, 10/63; P < .001) SOTr.
CONCLUSIONS
Invasive aspergillosis remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Although overall mortality has decreased in SOTr, it remains high in liver SOTr.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1111/tid.12898
- PMID 29668068
- Persistent URL
- https://folia.unifr.ch/global/documents/285440
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