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Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study

BACKGROUND: Invasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy. METHODS:...

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Detalles Bibliográficos
Autores principales: Desbois, Anne-Claire, Poiree, Sylvain, Snanoudj, Renaud, Bougnoux, Marie-Elisabeth, Sberro-Soussan, Rebecca, Lanternier, Fanny, Legendre, Christophe, Lortholary, Olivier, Scemla, Anne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082998/
https://www.ncbi.nlm.nih.gov/pubmed/27819031
http://dx.doi.org/10.1097/TXD.0000000000000584
Descripción
Sumario:BACKGROUND: Invasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy. METHODS: We retrospectively collected all cases of KTR-associated IA occurring at Necker Enfants Malades Hospital, Paris, from 2003 to 2013. These cases were compared with a group of controls (1:3) who were matched by age, year of kidney transplantation, and sex. The characteristics of IA were also studied. RESULTS: Sixteen patients developed IA after KTR. Most IA cases were limited to the lungs (81.3%), with mild respiratory symptoms in only 53% of the patients. The patients were administered voriconazole (n = 15, 94%) and/or posaconazole (n = 2, 13%). The 12-week and 1-year postinfection survival rates were 94% and 81%, respectively. Compared with the controls (n = 46), patients and death-censored graft survivals rates were significantly lower after IA (P = 0.017 and 0.001, respectively). In the patients with IA, the occurrences of cardiovascular diseases before transplantation (P < 0.0001), delayed graft function (P < 0.0001), and infectious complications (0.0018) were significantly more frequent. CONCLUSIONS: Even with voriconazole therapy, the prognosis of patients with IA after kidney transplantation is still poor. When the patients survive to IA, they have a high risk of graft loss.