Trends in risk profiles for and mortality associated with invasive aspergillosis among liver transplant recipients.
To discern whether the characteristics and outcome of invasive aspergillosis in liver transplant recipients have evolved during the past decade, 26 patients who underwent transplantation during 1990-1995 (known as "the earlier cohort") were compared with 20 patients who underwent transplantation during 1998-2001 (known as "the later cohort"). Twenty-three percent of the Aspergillus infections in the earlier cohort occurred > or =90 days after transplantation, compared with 55% of such infections in the later cohort (P=.026). The earlier cohort was significantly more likely to have disseminated infection (P=.034) and central nervous system (CNS) involvement (P=.0004) than was the later cohort. The mortality rate was significantly higher for the earlier cohort (92%) than for the later cohort (60%; P=.012). Only disseminated infection (not the year of transplantation) approached statistical significance as an independent predictor of outcome. In the current era, invasive aspergillosis occurs later in the posttransplantation period, is less likely to be associated with CNS infection, and is associated with a lower mortality rate, compared with invasive aspergillosis in the early 1990s.
Singh
Nina
N
Infectious Disease Section, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15240, USA. nis5+@pitt.edu
Avery
Robin K
RK
Munoz
Patricia
P
Pruett
Timothy L
TL
Alexander
Barbara
B
Jacobs
Richard
R
Tollemar
Jan G
JG
Dominguez
Edward A
EA
Yu
Chen M
CM
Paterson
David L
DL
Husain
Shahid
S
Kusne
Shimon
S
Linden
Peter
P
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001228:Aspergillosis / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D014180:Transplantation