Invasive Aspergillosis -Associated Immune Reconstitution Syndrome In Lung Transplant Recipients

Ref ID: 18692

Author:

N. Singh, MD – Professor 1, M. Wagener, MPH – Research Associate1, J. F. Suarez, MD – Professor 2, R. Avery, MD – Professor 3, C. Lass-Floerl, MD – Professor 4, A. C. Pasqualotto, MD – Professor 5, G. M. Lyon, MD – Professor 6, M. Barron, MD – Profes

Author address:

1U Pitt, Pittsburgh, PA, 2Stanford, Stanford, CA, 3Cleveland Clinic, Cleveland, OH, 4U Innsbruck, Innsbruck, Austria, 5UFCSPA, Porto Alegre, Brazil, 6Emory U, Atlanta, GA, 7U Denver, Denver, CO, 8U Toronto, U Toronto, Canada.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Incidence, characteristics, and risk-factors for IA-associated IRS in lung transplant recipients are not known. Methods: Patients comprised 69 lung transplant recipients with proven/probable IA per EORTC/MSG criteria. IRS was defined based on criteria for opportunistic mycoses-associated IRS in transplant recipients (Lancet Infect Dis 2007;7: 395). Results: IRS developed in 7 patients a median of 35d after antifungal therapy. Age, renal failure/dialysis at baseline, prior rejection or CMV infection, Aspegillus species, use/type of calcineurin-inhibitor agent (CNI), corticosteroid use/dose at baseline, and type of antifungal treatment for IA (voriconazole, echinocandin or polyene-based) did not correlate with IRS (p>0.10). Heart-lung vs. single/bilateral lung transplants (p=0.02), disseminated vs. localized IA (p=0.050), discontinuation vs. no change/any reduction of CNI (p=0.013), IA within 1y posttransplant (p=.038), and T-cell agent use (p=0.012) were associated with a higher risk of IRS. A model was constructed to test for a linear trend of the odds ratio for IRS with aforementioned variables in the model. All 7 IRS cases had atleast one of the variables. 11% of the patients with one factor, 25% with 2 factors and 50% with 3 factors had IRS (X2 for trend p<0.001); none of the cases had all 4 factors. Overall, 28.6% (2/7) of the patients required corticosteroids for the management of IRS. Survival at 12 weeks after IA was 42.9% (3/7) in patients with IRS and 80.3% (49/61) in those without IRS (p=0.048) Conclusions: Overall 10% of the lung transplant recipients appear to develop an IRS-like entity following IA. Clinically assessable factors can identify patients at risk for posttransplant IA-associated IRS. Lung transplant recipients with IA who developed IRS had poorer outcome than those without IRS.

Abstract Number: M-1227

Conference Year: 2012

Link to conference website: NULL

New link: NULL

Conference abstracts, posters & presentations

Showing 10 posts of 17325 posts found.

  • Title

    Author

    Year

    Number

    Poster