Invasive aspergillosis in renal transplant patients : a case control study

Maren Burbach 1, Marie-Noelle Peraldi 1, Matthieu Resche-Rigon 2, Anne Bergeron 3, Touratier Sophie 4, Bretagne Stéphane 5, Jean-Michel Molina 6, Alexandre Alanio 7, Blandine Denis*8.

Author address: 

1 Hôpital Saint Louis, Ap-Hp; Nephrology; 2 Université Paris Diderot; Hopital Saint Louis; Biostatistics; 3 Hôpital Saint Louis, Ap-Hp; Pneumology; 4 Hopital Saint-Louis; Pharmacy; 5 Institut Pasteur; Molecular Mycology Unit; 6 Hôpital Saint Louis; Infectious Diseases Department; Service de Maladies Infectieuses et Tropicales; 7 Institut Pasteur; Unité de Mycologie Moléculaire; 8 Hopital Saint-Louis.

Abstract: 

Background: Invasive aspergillosis (IA) is one of the most frequent invasive fungal infections (IFI) in
renal transplant (RT) recipients and is associated with a high morbi-mortality rate. Moreover, RT
recipients have a low cumulative incidence of IA compared to other solid organ recipients, which
makes IA risk factors and clinical outcomes difficult to assess.
Material/methods: We conducted a retrospective monocentric case-control study between 2006 and
June 2016 including all RT patients diagnosed with IA at Saint Louis Hospital, one of the major
transplant centers of Paris, France. Controls were patients transplanted immediately before or after
a case (1:3 ratio; N=39).
Results: We included 12 cases of probable IA and 1 case of proven IA. Mean time to diagnosis of IA
after renal transplantation was 406 days with 11 (84,6%) cases occurring 6 months after
transplantation. Mean age among cases was 63 years. None had chronic lung diseases or a recent
history of influenzae virus infection in the cases group. Induction immunosuppressive therapy
consisted in anti-thymocyte globulin in 84% of the cases versus 87% of controls. Most cases of IA
were of pulmonary origin (77%). A galactomannan assay was positive in serum in 7 (54%) cases. A
low lymphocyte count was a risk factor for IA; mean lymphocyte count was 200/mm3 versus
640/mm3 in the case and control group respectively (p: 0,03). Cases had more leucopenia (defined
as a leucocyte count<3000/mm3 ,12 cases (92%)) vs controls (1 patients, 3%) with an aplasia for
more than 10 days in the 3 months preceeding IA diagnosis in 2 cases (15%) vs 0 in controls. Cases
were also more likely to have a bacterial co-infection at time of diagnosis (OR: 16; 95% CI: 2,0-132,4;
p: 0,009) in comparison to controls. Cases had a higher but not significant prevalence of lymphoma (3
patients (23%) vs 1 patient (3%) in the case and control group respectively) and an increase of
corticosteroids above 0,2mg/kg in the 6 months preceding the diagnosis of IA (3 patients (23%)
versus 0 patient in the case and control group respectively). Cytomegalovirus reactivation occurred in
10 (78%) case patients 6 months before the diagnosis of IA. Survival rates at 3 months, 1 year and 3
years after onset of IA in RT patients were 83% (CI 95: 0,65-1), 74% (CI 95: 0,53-1) and 49% (CI 95:
0,21-1) respectively.
Conclusions: IA in RT patients was associated with a poor outcome with a 26% mortality rate at
one year despite prompt initiation of voriconazole in all patients. Classical IA predisposing host
factors were absent in most cases and we did not find chronic lung diseases among the IA cases. Our
results should be validated in a larger study in order to improve diagnosis and outcome.

2017

abstract No: 

P0964

Full conference title: 

27th European Congress of Clinical Microbiology and Infectious Diseases (2017, Vienna)
    • ECCMID 27th (2017)