title: Late-onset invasive aspergillosis in organ transplant recipients in the current era.
abstract: 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.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Graeme
authors.initials: G
authors.lastname: Forrest
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Fernando
authors.initials: F
authors.lastname: Rosso
authors.forename: Jose G
authors.initials: JG
authors.lastname: Montoya
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Patton
authors.forename: Ramon
authors.initials: R
authors.lastname: Del Busto
authors.forename: Jose M
authors.initials: JM
authors.lastname: Aguado
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: 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
chemical_list: D000906:Antibodies; D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D020123:Sirolimus; D016559:Tacrolimus