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Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

D Neofytos, O Chatzis, D Nasioudis, E Boely Janke, T Doco Lecompte, C Garzoni, C Berger, A Cussini, Katia Boggian, N Khanna, O Manuel, N J Mueller, C Van Delden & Swiss Transplant Cohort Study

abstract

BACKGROUND
There is lack of recent multicenter epidemiological data on invasive aspergillosis (IA) among solid organ transplant recipient (SOTr) in the mold-acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOTr using the Swiss Transplant Cohort Study.

METHODS
All consecutive SOTr with proven or probable IA between 01.05.2008 and 31.12.2014 were included. A case-control study to identify IA predictors was performed: 1-case was matched with 3-controls based on SOT type, transplant center, and time post-SOT.

RESULTS
Among 2868 SOTr, 70 (2.4%) patients were diagnosed with proven (N: 30/70, 42.9%) or probable (N: 40/70, 57.1%) IA. The incidence of IA was 8.3%, 7.1%, 2.6%, 1.3%, and 1.2% in lung, heart, combined, kidney and liver transplant recipients, respectively Galactomannan immunoassay was positive in 1/3 of patients tested. Only 33/63 (52.4%) of patients presented with typical pulmonary radiographic findings. Predictors of IA included: renal insufficiency, re-operation, and bacterial and viral infections. 12-week mortality was higher in liver (85.7%, 6/7) compared to other (15.9%, 10/63; P<0.001) SOTr.

CONCLUSIONS
IA remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Whereas overall mortality has decreased in SOTr, it remains high in liver SOTr. This article is protected by copyright. All rights reserved.
   
citation Neofytos D, Chatzis O, Nasioudis D, Boely Janke E, Doco Lecompte T, Garzoni C, Berger C, Cussini A, Boggian K, Khanna N, Manuel O, Mueller N J, van Delden C, Swiss Transplant Cohort Study . Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study. Transpl Infect Dis 2018;e12898.
   
type journal paper/review (English)
date of publishing 18-04-2018
journal title Transpl Infect Dis
ISSN electronic 1399-3062
pages e12898
PubMed 29668068
DOI 10.1111/tid.12898