Invasive Aspergillosis among Heart Transplant Recipients Occurs in Clusters and Remains Associated with Rapid Mortality

Ref ID: 18662

Author:

R. K. Shields – Assistant Professor of Medicine, C. J. Clancy – Associate Professor of Medicine, E. J. Kwak – Assistant Professor of Medicine, F. P. Silveira – Assistant Professor of Medicine, R. C. Abdel Massih – Assistant Professor of Medicine, Y.

Author address:

Univ. of Pittsburgh, Pittsburgh, PA.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: We reported that invasive aspergillosis (IA) is common among lung transplant (LTx) patients (pts) at our center, but mortality has decreased. Compared to LTx, IA is less well-described among heart transplant (HTx) pts. Methods: 11-year retrospective study of HTx pts with proven or probable IA. Results: 479 consecutive HTx were enrolled. Aspergillus was isolated from 8 pts (2%), including 4 with acute IA (disease within 90 days of HTx), 3 with chronic IA, and 1 with colonization. Each case of IA was pneumonia, caused by A. fumigatus (6) or A. versicolor (1). 6 pts with IA presented within two 5-month periods in 2006 and 2010-11 (3 pts in each). Among pts with acute IA, median time to diagnosis post-HTx was 17 days (range 9-33). 100% (4/4) of pts required post-HTx hemodialysis (HD), re-operation, mechanical support, and intubation for > 7 days. 75% (3/4) of pts had open chests following HTx. Treatment regimens were caspofungin (CAS) plus voriconazole (VOR) (3 pts) and amphotericin B lipid complex plus CAS (1 pt). 100% (4/4) of pts failed treatment; median survival after diagnosis was 9.5 days (range 9-20). 3 pts with chronic IA developed disease 129 days, 3.1, and 7.8 years after HTx. 1 pt was previously colonized. 100% (3/3) of pts required HD at time of IA, 67% (2/3) received high-dose steroids with 30 days of diagnosis, and 67% (2/3) had ≥ 1 prior episode of CMV viremia. 2 pts who received CAS plus VOR expired 4 and 18 days after diagnosis. The third pt received 6 months of itraconazole and survived. Overall, 30-day mortality for IA among HTx pts was 86% (6/7). Conclusions: Unlike our experience with LTx pts, IA is rare in HTx pts but remains rapidly fatal. Risk factors for acute IA include post-HTx mechanical support, prolonged intubation, re-operation, and open chest. Possible risks for chronic disease include high-dose steroids and CMV. HD and another case of IA within the HTx program during the preceding several months are risk factors for both acute and chronic disease. In response to a new case of IA, programs may consider antifungal prophylaxis among high-risk pts.

Abstract Number: K-862

Conference Year: 2012

Link to conference website: NULL

New link: NULL


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