Differences of invasive aspergillosis in solid organ trasplant according to the type of allograft

Ref ID: 19234

Author:

I. Hoyo*, G. Sanclemente, J. Puig de la Bellacasa, F. Cofán, M. Ricart, J. Colmenero, J. Fernández, A. Escorsell, M. Cardona, A. Moreno, C. Cervera

Author address:

Barcelona, ES

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Objectives: Invasive aspergillosis (IA) is a major cause of morbidity and mortality in transplant patients. The aim of this study was to describe the clinical features of IA in solid organ trasplants(SOT) patients.
Methods: From June 2003 to December 2010, 1762 patients underwent solid organ transplantation at our centre. Using the computerized database of infections in SOT we identified all cases of IA. Proven or probable IA was defined according to the EORTC/MSG
Results: A total of 27 patients were included (68% male, median age 59 y). By type of transplant 57% were liver, 33% kidney and 11% double transplant. The incidence of IA after all SOT was 1.5% (27/1762) and by type of allograft: 0.7% (1/139) in simultaneous kidney-pancreas, 1% (9/863) in kidney, 2.5% (15/589) in liver and 5.5% (2/36) in liver-kidney. There were no cases of IA in heart transplant recipients. The median onset time from all transplants to IA was 37 days and by type of transplant: 7 days in liver and 217 days in kidney. There were 6 cases (22%) of late IA, all in kidney recipients. These patients also had chronic lung or (3/6), liver disease (viral hepatitis) (2/6) or long admission to the ICU (1/6).
Of our cohort, 76% of the liver recipients had clinical risk factors for IA and 35% received antifungal prophylaxis. The distribution of probable and proven IA was 89% vs 11%.
By type of infection, 96% (26/27) of the cases were pulmonary. There was microbiological isolation in 24/27 patients (88%) and the most common sample for aspergillus recovery was BAL (83%,20/24). The species most frequently encountered was A. fumigatus, (66%,16/24).
In 25 out of 27 patients, galactomannan (GM) serum antigen was tested, and mortality was higher in those with positive GM (14/25, 56% vs. 2/11, 18%) (p=0.021). In a regression model adjusting mortality by age, IA in kidney recipients and late-onset IA, a positive GM antigen in serum remained as an independent variable associated with higher risk of mortality (OR 8.1, 95%CI 1.2-53.2, p=0.029).
Conclusion: While the classical risk factors described for invasive aspergillosis in liver recipients are still valid, IA in renal patients appears later and it’s commonly associated with comorbid conditions, such as chronic lung or hepatic disease or long ICU admissions. A positive serum GM test increased near 8-fold IA-associated mortality.

Abstract Number: P2139

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=166219&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

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