Trends in Risk-Profiles and Mortality due to Invasive Aspergillosis in Organ Transplant Recipients

N. SINGH1, R. AVERY 2, P. MUNOZ 3, B. ALEXANDER 4, and Aspergillus Collab Transplant Study Gp.

Author address: 

1VA MC, Pittsburgh, PA, 2CCF, Cleveland, OH, 3Hosp Gregorio Maranon, Madrid, Spain, 4Duke U Med Ctr, Durham, NC.

Abstract: 

Background:To determine if the epidemiology, risk factors and outcome of invasive aspergillosis in organ transplant recipients have evolved over the decade. Methods: A cohort of 26 organ transplant recipients transplanted between 1990-95 (earlier cohort) was compared with 27 patients transplanted between 1998-2001 (later cohort). Of 53 patients with IA, 44 were liver and 9 heart transplant recipients. Data were multicenter and prospectively collected. All patients fulfilled the MSG criteria for IA. Results: The earlier cohort had greater severity of hepatic dysfunction (T. bilirubin 22 vs. 3 mg/dl, p = .004), was more likely to have renal failure, i.e., creatinine >2 mg/dl (69% vs. 41%, p = .04), to be in the ICU at the time of diagnosis (81% vs. 56%, p = .049), but less likely to have preceding rejection (4% vs. 30%, p=.024) than the later cohort with IA. Number of patients with retransplantation, CMV infection and type of primary immunosuppressive agent were not different for the two cohorts. 81% of the Aspergillus spp. in both cohorts were fumigatus.The later cohort was more likely to have late-onset IA, i.e., infection after 3 months posttransplant (52% vs. 23%, p = .031), to have received a liposomal AmB preparation (72% vs. 36%, p = .011), but less likely to have CNS involvement (4% vs. 36%, p=.0003).Mortality was significantly lower in the later vs. the earlier cohort (63% vs. 92%, p = .02). Conclusions: Risk profile of organ transplant recipients developing IA has changed. IA in the current era occurs later, is less likely to be associated with CNS disease, and has lower mortality than in the early 1990s.
2002

abstract No: 

M-867

Full conference title: 

42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 42nd