Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study

被引：36

作者：

Lopez-Medrano, F. ^{[1
]}

Silva, J. T. ^{[1
]}

Fernandez-Ruiz, M. ^{[1
]}

Carver, P. L. ^{[2
]}

van Delden, C. ^{[3
]}

Merino, E. ^{[4
]}

Perez-Saez, M. J. ^{[5
]}

Montero, M. ^{[6
]}

Coussement, J. ^{[7
]}

de Abreu Mazzolin, M. ^{[8
,9
]}

Cervera, C. ^{[10
]}

Santos, L. ^{[11
]}

Sabe, N. ^{[12
]}

Scemla, A. ^{[13
]}

Cordero, E. ^{[14
]}

Cruzado-Vega, L. ^{[15
]}

Martin-Moreno, P. L. ^{[16
]}

Len, O. ^{[17
]}

Rudas, E. ^{[18
]}

Ponce de Leon, A. ^{[19
]}

Arriola, M. ^{[20
]}

Lauzurica, R. ^{[21
]}

David, M. ^{[22
]}

Gonzalez-Rico, C. ^{[23
]}

Henriquez-Palop, F. ^{[24
]}

Fortun, J. ^{[25
]}

Nucci, M. ^{[26
]}

Manuel, O. ^{[27
,28
]}

Pano-Pardo, J. R. ^{[29
,30
]}

Montejo, M. ^{[31
]}

Munoz, P. ^{[32
]}

Sanchez-Sobrino, B. ^{[33
]}

Mazuecos, A. ^{[34
]}

Pascual, J.

Horcajada, J. P.

Lecompte, T.

Lumbreras, C. ^{[1
]}

Moreno, A.

Carratala, J.

Blanes, M. ^{[35
]}

Hernandez, D.

Hernandez-Mendez, E. A.

Farinas, M. C.

Perello-Carrascosa, M. ^{[36
]}

Morales, J. M. ^{[37
]}

Andres, A.

Aguado, J. M. ^{[1
]}

机构：

[1] Univ Complutense, Inst Invest Hosp Octubre I 12 12, Hosp Univ Octubre 12, Unit Infect Dis,Dept Med,Sch Med, Madrid, Spain

[2] Univ Michigan Hlth Syst, Ann Arbor, MI USA

[3] Univ Hosp Geneva, Dept Med Special, Infect Dis Serv, Geneva, Switzerland

[4] Hosp Univ Gen, Infect Dis Unit, Alicante, Spain

[5] Hosp del Mar Med Res Inst IMIM, Dept Nephrol, Barcelona, Spain

[6] Hosp del Mar Med Res Inst IMIM, Dept Infect Dis, Barcelona, Spain

[7] Univ Libre Bruxelles, Hop Erasme, Dept Nephrol Dialysis & Kidney Transplantat, Brussels, Belgium

[8] Univ Fed Sao Paulo UNIFESP, Dept Med, Div Nephol, Sao Paulo, Brazil

[9] Fundacao Oswaldo Ramos, Hosp Rim & Hipertensao, Sao Paulo, Brazil

[10] Univ Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Sch Med, Dept Infect Dis,Hosp Clin, Barcelona, Spain

[11] Coimbra Hosp & Univ Ctr, Dept Urol & Kidney Transplantat, Renal Transplantat Unit, Coimbra, Portugal

[12] Hosp Univ Bellvitge, Inst Invest Biomed Bellvitge IDIBELL, Dept Infect Dis, Barcelona, Spain

[13] Univ Paris 05, Hop Necker Enfants Malad, AP HP,RTRS Centaure, Serv Nephrol & Transplantat Adulte,Sorbonne Paris, Paris, France

[14] Hospit Univ Vigen del Rocio, Inst Biomed Sevilla IBIS, Infect Dis Unit, Seville, Spain

[15] Hosp Univ La Fe, Dept Nephrol, Valencia, Spain

[16] Univ Navarra Clin, Dept Nephrol, Pamplona, Spain

[17] Hosp Univ Vall dHebron, Vall dHebron Res Inst VHIR, Dept Infect Dis, Barcelona, Spain

[18] Hosp Univ Carlos Haya, Dept Nephrol, Malaga, Spain

[19] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Transplantat, Mexico City, DF, Mexico

[20] Clin Nefrol Urol & Enfermedades Cardiovasc, Santa Fe, NM, Argentina

[21] Univ Hosp Germans Trias & Pujol, Dept Nephrol, Barcelona, Spain

[22] Univ Hosp Birmingham NHS Fdn Trust, Dept Microbiol, Birmingham, W Midlands, England

[23] Univ Hosp Marques de Valdecilla, Dept Infect Dis, Santander, Spain

[24] Univ Hosp Doctor Negrin, Dept Nephrol, Las Palmas Gran Canaria, Spain

[25] Univ Hosp Ramon y Cajal, Dept Infect Dis, Madrid, Spain

[26] Univ Fed Rio de Janeiro, Univ Hosp Clementino Fraga Filho, Dept Internal Med Hematol Serv & Mycol Lab, Rio De Janeiro, Brazil

[27] Univ Hosp CHUV, Dept Infect Dis, Lausanne, Switzerland

[28] Univ Hosp CHUV, Transplantat Ctr, Lausanne, Switzerland

[29] Univ Lausanne, Lausanne, Switzerland

[30] Univ Autonoma Madrid, Hosp Univ La Paz, Dept Internal Med, Sch Med, Madrid, Spain

[31] Hosp Univ Cruces, Dept Infect Dis, Bilbao, Spain

[32] Hosp Gen Univ Gregorio Maranon, Dept Microbiol & Infect Dis, Madrid, Spain

[33] Univ Autonoma Madrid, Hosp Univ Puerta de Hierro Majadahonda, Sch Med, Dept Nephrol, Madrid, Spain

[34] Hosp Univ Puerta del Mar, Dept Nephrol, Cadiz, Spain

[35] Hosp Univ La Fe, Infect Dis Unit, Valencia, Spain

[36] Hosp Univ Vall dHebron, Vall dHebron Res Inst VHIR, Dept Nephrol, Barcelona, Spain

[37] Univ Complutense, Hosp Univ Octubre 12, Inst Invest Hosp Octubre I 12 12, Dept Nephrol,Dept Med,Sch Med, Madrid, Spain

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2016年 / 16卷 / 07期

关键词：

clinical research; practice; infectious disease; kidney transplantation; nephrology; infection and infectious agents; fungal; epidemiology; TARGETED ANTIFUNGAL PROPHYLAXIS; FUNGAL-INFECTIONS; CLINICAL CHARACTERISTICS; EPIDEMIOLOGY; HEART; DISEASE; KINETICS; OUTCOMES; FRANCE;

D O I：

10.1111/ajt.13735

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group. A multinational case-control study in kidney transplant recipients finds that pretransplant diagnosis of chronic obstructive pulmonary disease, delayed graft function, bloodstream infection and acute graft rejection identify patients at the highest risk for early invasive pulmonary aspergillosis.

引用

页码：2148 / 2157

页数：10

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