Late-onset invasive aspergillosis in organ transplant recipients in the current era.
We assessed predictive factors and characteristics of patients with late-onset invasive aspergillosis in the current era of novel immunosuppressive agents. Forty transplant recipients with invasive aspergillosis were included in this prospective, observational study initiated in 2003 at our institutions. In 50% (20/40) of these patients, the infections were late-occurring. Receipt of sirolimus in conjunction with tacrolimus for refractory rejection or cardiac allograft vasculopathy (P=0.047) was significantly associated with late-onset infection. The use of depleting or non-depleting T or B-cell antibodies, either as induction or as antirejection therapy did not correlate with time to onset of invasive aspergillosis. Mortality at 90 days was 20% (4/20) for the patients with early-onset infection and 45% (9/20) for those with late-onset infection (P=0.17). Thus, nearly one-half of the Aspergillus infections in transplant recipients in the current era are late-occurring. These data have implications relevant for prophylactic strategies and guiding clinical management of transplant recipients presenting with pulmonary infiltrates.
Singh
Nina
N
University of Pittsburgh, Pittsburgh, PA, USA. nis5@pitt.edu
Limaye
Ajit P
AP
Forrest
Graeme
G
Safdar
Nasia
N
Muñoz
Patricia
P
Pursell
Kenneth
K
Houston
Sally
S
Rosso
Fernando
F
Montoya
Jose G
JG
Patton
Pamela R
PR
Del Busto
Ramon
R
Aguado
Jose M
JM
Wagener
Marilyn M
MM
Husain
Shahid
S
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000906:Antibodies / Q000008:administration & dosage / Q000276:immunology; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D001402:B-Lymphocytes / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*; D013030:Spain; D013601:T-Lymphocytes / Q000276:immunology; D016559:Tacrolimus / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States
D000906:Antibodies; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus