OBJECTIVES:To determine the value of the detection of aspergillus antigen in serum using a ELISA test in liver transplant (LTX) recipients. METHODS: Stored frozen serum specimens obtained during postransplantation period from patients included in a case-control study of invasive aspergillosis (IA) in LTX recipients were used. As Case-patient(CS-P)was considered a LTX recipient with a definitive diagnosis of IA by histologic and/or microbiological confirmation. Control-patients (CNT-P)were the 3 most nearest LTX recipients in time from CS-P transplantation date. Aspergillus antigen detection in serum using a sandwich-ELISA method (Platelia Aspergillus, Sanofi Diagn Pasteur) was performed in the samples. A value of 1 ng/mL in serum was considered positive.A CS-P was considered valuable for antigenemia detection if 3 serums, separated in time, were available and if one of those samples had been obtained within the month before IA diagnosis. A CNT-P was valuable if 3 serums obtained during the first 6 months after TX were available. RESULTS: 14 cases of IA were diagnosed in 240 LTX recipients (IA incidence: 1.6%) and 13 of them died (93%). 42 CNT-P were chosen. 8 CS-P and 34 CNT-P met the criteria required for been considered valuable for antigenemia analysis. In 5 of the 8 CS-patients,a serum sample was positive for aspergillus antigenemia detection. Median value was 5,7 ng/mL (range: 1.6- 6,6). In 34 CNT-patients, 2 of them had a false positive result.In this study, aspergillus antigenemia ELISA test has a sensitivity (S) of 62.5%,an specificity(E)of 94%, a positive predictive value (PPV) of 71,4% and a negative predictive value (NPV) of 91,4%. CONCLUSIONS:IA is a fungal infection with a poor prognosis in TX patients. In a retrospective case-control study of IA in LTX patients, the results obtained shows that detection of aspergillus galactomannan in serum using sandwich-ELISA test is a reliable serodiagnosis method for IA diagnosis in LTX patients (S:62,5%; E:94%;NPV:91,4%;PPV:71,4%). High positive antigenemia values (5 ng/mL)were obtained in 60% of IA cases.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th