Risk factors of invasive aspergillosis after heart transplantation: protective role of oral itraconazole prophylaxis.
The study was designed to identify a subset of heart transplant (HT) recipients who could benefit from the administration of targeted antifungal prophylaxis and to evaluate the efficacy of oral itraconazole as the preventive drug. We have analyzed the risk factors for invasive aspergillosis (IA) in our entire population of HT recipients (1988-2002) and also the role of oral itraconazole prophylaxis that was provided to all patients since 1995 [400 mg q.d. of itraconazole oral (PO) for 3-6 months]. There were 24 cases of IA. Our main results indicate that the independent risk factors for IA after heart transplantation are: re-operation (RR 5.8; 95% CI 1.8-18, p=0.002), cytomegalovirus (CMV) disease (RR 5.2; 95% CI 2-13.9, p=0.001), post-transplant hemodialysis (RR 4.9; 95% CI 1.2-18, p=0.02), and the existence of an episode of IA in the HT program 2 months before or after the transplantation date (RR 4.6; 95% CI 1.5-14.4, p=0.007). Itraconazole prophylaxis showed an independent protective value against developing IA (RR 0.2; 95% CI 0.07-0.9, p=0.03) and also determined a significantly prolonged 1-year survival (RR 0.5; 95% CI 0.3-0.8, p=0.01). We believe that antifungal prophylaxis in heart transplant patients should be offered at least to patients with one or more of these predisposing conditions.
Muñoz
Patricia
P
Department of Clinical Microbiology-Infectious Diseases, Hospital General Universitario Gregorio Maranon, Madrid, Spain. pmunoz@micro.hggm.es
Rodríguez
Claudia
C
Bouza
Emilio
E
Palomo
Jesús
J
Yañez
Juan F
JF
Domínguez
María Jesús
MJ
Desco
Manuel
M
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000209:etiology*; D003587:Cytomegalovirus / Q000378:metabolism; D003586:Cytomegalovirus Infections / Q000209:etiology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D017964:Itraconazole / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D017964:Itraconazole