Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation.
- López-Medrano F Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain. Electronic address: flmedrano@yahoo.es.
- Fernández-Ruiz M Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
- Silva JT Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
- Carver PL University of Michigan College of Pharmacy, Department of Clinical Pharmacy, University of Michigan Health System, Ann Arbor, MI, USA.
- van Delden C Unit of Transplant Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland.
- Merino E Unit of Infectious Diseases, Hospital Universitario General, Alicante, Spain.
- Pérez-Saez MJ Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- Montero M Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- Coussement J Department of Nephrology, Dialysis and Kidney Transplantation, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
- de Abreu Mazzolin M Division of Nephrology, Department of Medicine, Universidade Federal de São Paulo-UNIFESP and Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, São Paulo, Brazil.
- Cervera C Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain.
- Santos L Unit of Renal Transplantation, Department of Urology and Kidney Transplantation, Coimbra Hospital and University Centre, Coimbra, Portugal.
- Sabé N Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
- Scemla A Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Paris, France.
- Cordero E Department of Infectious Diseases, Hospitales Universitarios "Vigen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain.
- Cruzado-Vega L Department of Nephrology, Hospital Universitario "La Fe", Valencia, Spain.
- Martín-Moreno PL Department of Nephrology, Clínica Universitaria de Navarra, Pamplona, Spain.
- Len Ó Department of Infectious Diseases, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Rudas E Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain.
- Ponce de León A Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, Mexico.
- Arriola M Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina.
- Lauzurica R Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
- David MD Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- González-Rico C Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain.
- Henríquez-Palop F Department of Nephrology, University Hospital "Doctor Negrín", Las Palmas de Gran Canaria, Spain.
- Fortún J Department of Infectious Diseases, University Hospital "Ramón y Cajal", Madrid, Spain.
- Nucci M Department of Internal Medicine, Hematology Service and Mycology Laboratory, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
- Manuel O Department of Infectious Diseases and Transplantation Center, University Hospital (CHUV) and University of Lausanne, Switzerland.
- Paño-Pardo JR Infectious Diseases and Clinical Microbiology Unit, Department of Internal Medicine, Hospital Universitario "La Paz", School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
- Montejo M Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Bilbao, Spain.
- Vena A Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Sánchez-Sobrino B Department of Nephrology, Hospital Universitario Puerta de Hierro-Majadahonda, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
- Mazuecos A Department of Nephrology, Hospital Universitario "Puerta del Mar", Cádiz, Spain.
- Pascual J Department of Nephrology, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- Horcajada JP Department of Infectious Diseases, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
- Lecompte T Unit of Transplant Infectious Diseases, Department of Medical Specialities, University Hospitals Geneva, Geneva, Switzerland.
- Moreno A Department of Infectious Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), School of Medicine, University of Barcelona, Barcelona, Spain.
- Carratalà J Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
- Blanes M Unit of Infectious Diseases, Hospital Universitario "La Fe", Valencia, Spain.
- Hernández D Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain.
- Hernández-Méndez EA Department of Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México DF, Mexico.
- Fariñas MC Department of Infectious Diseases, University Hospital "Marqués de Valdecilla", Santander, Spain.
- Perelló-Carrascosa M Department of Nephrology, Hospital Universitari Vall d'Hebrón, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
- Muñoz P Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Andrés A Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
- Aguado JM Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
- 2017-06-28
Published in:
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. - 2018
Case-control study
Kidney transplantation
Late invasive pulmonary aspergillosis
Risk factors
Case-Control Studies
Female
Global Health
Humans
Invasive Pulmonary Aspergillosis
Kidney Transplantation
Male
Middle Aged
Retrospective Studies
Risk Factors
Time Factors
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.cmi.2017.06.016
- PMID 28652112
- Persistent URL
- https://sonar.ch/global/documents/46751
Statistics
Document views: 18
File downloads:
- Full-text: 0