RT Journal Article
T1 Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study.
A1 Lopez-Medrano, F
A1 Fernandez-Ruiz, M
A1 Silva, J T
A1 Carver, P L
A1 van-Delden, C
A1 Merino, E
A1 Perez-Saez, M J
A1 Montero, M
A1 Coussement, J
A1 de-Abreu-Mazzolin, M
A1 Cervera, C
A1 Santos, L
A1 Sabe, N
A1 Scemla, A
A1 Cordero, E
A1 Cruzado-Vega, L
A1 Martin-Moreno, P L
A1 Len, O
A1 Rudas, E
A1 de-Leon, A P
A1 Arriola, M
A1 Lauzurica, R
A1 David, M
A1 Gonzalez-Rico, C
A1 Henriquez-Palop, F
A1 Fortun, J
A1 Nucci, M
A1 Manuel, O
A1 Paño-Pardo, J R
A1 Montejo, M
A1 Muñoz, P
A1 Sanchez-Sobrino, B
A1 Mazuecos, A
A1 Pascual, J
A1 Horcajada, J P
A1 Lecompte, T
A1 Moreno, A
A1 Carratala, J
A1 Blanes, M
A1 Hernandez, D
A1 Fariñas, M C
A1 Andres, A
A1 Aguado, J M
K1 Antibiotic: antifungal
K1 Clinical research/practice
K1 Complication: infectious
K1 Fungal
K1 Infection and infectious agents
K1 Infectious disease
K1 Kidney transplantation/nephrology
AB 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.
PB Elsevier
YR 2016
FD 2016-04-17
LK http://hdl.handle.net/10668/10018
UL http://hdl.handle.net/10668/10018
LA en
NO López-Medrano F, Fernández-Ruiz M, Silva JT, Carver PL, van Delden C, Merino E, et al. Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study. Am J Transplant. 2016 Nov;16(11):3220-3234
NO This research was supported by the Plan Nacional de I+D+i and Instituto de Salud Carlos III (Proyecto Integrado de Excelencia [PIE] 13/00045), Subdirección General de Redes y Centros de Investigación Cooperativa, Spanish Ministry of Economy and Competitiveness, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015)—co-financed by the European Development Regional Fund (EDRF) “A way to achieve Europe.” The study was also co-financed with an unrestricted grant from Pfizer Pharmaceutical (REI-ANT-2013-01). Mario Fernández-Ruiz holds a clinical research contract “Juan Rodríguez” (JR14/00036) from the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness.
DS RISalud
RD Apr 11, 2025