Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

Author Lopez-Medrano, F. Google Scholar
Fernandez-Ruiz, M. Google Scholar
Silva, J. T. Google Scholar
Carver, P. L. Google Scholar
van Delden, C. Google Scholar
Merino, E. Google Scholar
Perez-Saez, M. J. Google Scholar
Montero, M. Google Scholar
Coussement, J. Google Scholar
de Abreu Mazzolin, M. Autor UNIFESP Google Scholar
Cervera, C. Google Scholar
Santos, L. Google Scholar
Sabe, N. Google Scholar
Scemla, A. Google Scholar
Cordero, E. Google Scholar
Cruzado-Vega, L. Google Scholar
Martin-Moreno, P. L. Google Scholar
Len, O. Google Scholar
Rudas, E. Google Scholar
Ponce de Leon, A. Google Scholar
Arriola, M. Google Scholar
Lauzurica, R. Google Scholar
David, M. D. Google Scholar
Gonzalez-Rico, C. Google Scholar
Henriquez-Palop, F. Google Scholar
Fortun, J. Google Scholar
Nucci, M. Google Scholar
Manuel, O. Google Scholar
Pano-Pardo, R. Google Scholar
Montejo, M. Google Scholar
Vena, A. Google Scholar
Sanchez-Sobrino, B. Google Scholar
Mazuecos, A. Google Scholar
Pascual, J. Google Scholar
Horcajada, J. P. Google Scholar
Lecompte, T. Google Scholar
Moreno, A. Google Scholar
Carratala, J. Google Scholar
Blanes, M. Google Scholar
Hernandez, D. Google Scholar
Hernandez-Mendez, E. A. Google Scholar
Farinas, M. C. Google Scholar
Perello-Carrascosa, M. Google Scholar
Munoz, P. Google Scholar
Andres, A. Google Scholar
Aguado, J. M. Google Scholar
Abstract 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. (c) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords Case-control study
Kidney transplantation
Late invasive pulmonary aspergillosis
Risk factors
xmlui.dri2xhtml.METS-1.0.item-coverage Oxford
Language English
Sponsor Pfizer
Gilead Sciences
Astellas Pharma
Merck Sharp
Lophius Bioscience
Instituto de Salud Carlos III
Plan Nacional de I+D+i and Instituto de Salud Carlos III (Proyecto Integrado de Excelencia (PIE) |Subdireccion General de Redes y Centros de Investigacion Cooperativa
Spanish Ministry of Economy and Competitiveness
Spanish Network for Research in Infectious Diseases
European Development Regional Fund (EDRF) "A way to achieve Europe"
Pfizer Pharmaceutical
contract "Juan Rodes" from the Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness
Grant number PIE: 13/00045
REIPI RD12/0015]
Spanish Ministry of Economy and Competitiveness: JR14/00036
Date 2018
Published in Clinical Microbiology And Infection. Oxford, v. 24, n. 2, p. 192-198, 2018.
ISSN 1198-743X (Sherpa/Romeo, impact factor)
Publisher Elsevier Sci Ltd
Extent 192-198
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000424846600019

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