Invasive aspergillosis among heart transplant recipients: a 24-year perspective

Ref ID: 17744

Author:

P. Muñoz*, I. Cerón, M. Valerio, J. Palomo, A. Villa, A. Eworo,
J. Guinea, I.A. González, E. Bouza

Author address:

(Madrid, ES)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Background: Invasive aspergillosis (IA) has very high mortality in
heart transplant (HT) patients (pts). However, no recent series provide
an updated, non-biased perspective of the problem.
Methods: Prospective follow-up of all HT pts from Aug 1988 to Aug
2011 (24-year study) with IA. Antifungal prophylaxis was started in
Oct 1994.
Results: IA was diagnosed in 31/479 consecutive HT pts (6.5%): 25
proven (80.6%) and 6 probable. The incidence of IA decreased: 74% of
the cases occurred in the first 12 years (1988-1999). Early IA (first
3 month after HT) accounted for 23 cases (median 34 day after Tx [19-
58]) and eight cases (26%) were late (median 125.5 days after HT
[100-237]). The main risk factors were other cases of IA in the program
(58.1%), CMV disease (54.8%), re-operation (38.7%) and post-Tx
hemodialysis (19.4%). IA emerged despite antifungal prophylaxis in
eight cases with low levels (7 itra, 1 caspo). The most common
symptoms were fever (45%), dyspnoea (35%) and cough (32%). Six pts
were asymptomatic (19%). The predominant radiographic patterns were
nodular (58%), cavitation (42%), pleural fluid (39%) and alveolar
infiltrate (23%). IA affected the lungs (90.3%), central nervous system
(CNS) (16%), mediastinum (9.7%), myocardium (6.5%) and skin,
prostate and paranasal sinuses (3.2% each). Dissemination occurred in
26%. The efficacy of the diagnostic methods was as follows: culture 27/
30 (90%) and PCR 4/5 (80%). Monotherapy was used in 77%
(amphotericin B, 7; lipid amphotericin B, 12; voriconazole, 2),
combined therapy in 7 pts (2 as rescue therapy) and surgery in 7
(22.6%). In four cases of early IA, diagnosis was postmortem. Related
mortality was 32% (43.5% [10/23] in 1988-1999 cases and 0/8 in
2000-2011). Mortality was lower in early cases (16% vs 58%,
p = 0.074). Risk factors for mortality in the univariate analysis were
long pre-Tx stay, pre-Tx mechanical ventilation (MV), emergency
surgery, OKT3 induction, concomitant CMV disease, CNS
involvement (mortality 100%), alveolar infiltrate, need of MV
(mortality 50%) and thrombocytopenia. Multivariate analysis showed
that CNS involvement and CMV during IA were independent risk
factors for mortality.
Conclusion: The incidence of IA in HT has decreased, partially due to
implementation of antifungal prophylaxis. Most cases occur in the first
3 months post-HT with a high frequency of disseminated disease and
atypical sites of infection (heart, mediastinum, prostate). Mortality has
decreased significantly in recent years.

Abstract Number: P804

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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