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

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

Author Lopez-Medrano, F. Google Scholar
Silva, J. T. Google Scholar
Fernandez-Ruiz, M. 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. 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, J. R. Google Scholar
Montejo, M. Google Scholar
Munoz, P. Google Scholar
Sanchez-Sobrino, B. Google Scholar
Mazuecos, A. Google Scholar
Pascual, J. Google Scholar
Horcajada, J. P. Google Scholar
Lecompte, T. Google Scholar
Lumbreras, C. 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
Morales, J. M. Google Scholar
Andres, A. Google Scholar
Aguado, J. M. Google Scholar
Abstract 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.
Keywords clinical research
practice
infectious disease
kidney transplantation
nephrology
infection and infectious agents
fungal
epidemiology
xmlui.dri2xhtml.METS-1.0.item-coverage Hoboken
Language English
Date 2016
Published in American Journal Of Transplantation. Hoboken, v. 16, n. 7, p. 2148-2157, 2016.
ISSN 1600-6135 (Sherpa/Romeo, impact factor)
Publisher Wiley-Blackwell
Extent 2148-2157
Origin http://dx.doi.org/10.1111/ajt.13735
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000379727800023
URI https://repositorio.unifesp.br/handle/11600/57662

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