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Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study
Author(s) -
Neofytos D.,
Chatzis O.,
Nasioudis D.,
Boely Janke E.,
Doco Lecompte T.,
Garzoni C.,
Berger C.,
Cussini A.,
Boggian K.,
Khan.,
Manuel O.,
Mueller N.J.,
van Delden C.
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12898
Subject(s) - medicine , epidemiology , aspergillosis , galactomannan , cohort , incidence (geometry) , liver transplantation , transplantation , gastroenterology , surgery , immunology , physics , optics
Background There is lack of recent multicenter epidemiological data on invasive aspergillosis ( IA ) among solid organ transplant recipient ( SOT r) in the mold‐acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOT r using the Swiss Transplant Cohort Study. Methods All consecutive SOT r 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 SOT r, 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) SOT r. 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 SOT r, it remains high in liver SOT r.