[Early diagnosis and treatment of invasive pulmonary aspergillosis following kidney transplantation].
OBJECTIVE
To investigate the early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) infection following kidney transplantation.


METHODS
A retrospective analysis was carried out in 16 IPA patients after kidney transplantation from January 2002 to March 2008. There were 7 males and 9 females with a mean age of 42.9 years old. The prevalence of IPA was 2.21%. The induction therapy was given to 12 patients, 5 with CD25 monoclonal antibody and 7 with anti-thymocyte globulin (ATG). All 6 with acute pre-infection rejection were given the methylprednisolone sodium or ATG therapy.


RESULTS
The intervals between transplantation and diagnosis were largely within 3 months. Persistent or intermittent fever was the main post-operative symptom. High resolution computed tomography (HRCT) of thorax and bronchoalveolar lavage fluid (BALF) for culture were the main evidence of clinical diagnosis. Amphotericin B (0.15 - 0.5 mg * kg(-1) * d(-1)) might be the major treatment for IPA because of its satisfactory initial therapeutic effect. The mortality rate was 7/16 (43.75%). Of the 9 surviving patients, 8 were treated before the test results were available.


CONCLUSIONS
The clinical symptoms of IPA following kidney transplantation are atypical in the early stage so that it is easy to misdiagnoses and a high mortality rate ensues. Major risk factors for IPA include administration of ATG, CD25 monoclonal antibody and steroid boluses for prevention or treatment of allograft rejection; prolonged broad-spectrum antibiotic use after transplantation and environmental factors. Early diagnosis and empirical use of antifungal agents while waiting for a definitive diagnosis are imperative in achieving a favorable outcome.
Wang
Wei
W
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China. zico73@medmail.com.cn
Li
Xiao-bei
XB
Ding
Yi
Y
Yin
Hang
H
Liu
Hang
H
Hu
Xiao-peng
XP
Wang
Yong
Y
Zhang
Xiao-dong
XD
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000935:Antifungal Agents