Immune reconstitution syndrome-like entity in lung transplant recipients with invasive aspergillosis.
BACKGROUND
Incidence, characteristics, and risk-factors for invasive aspergillosis (IA)-associated immune reconstitution syndrome (IRS) in lung transplant recipients are not known.


METHODS
Patients comprised 68 lung transplant recipients with proven/probable IA followed for 12 months. IRS was defined based on previously proposed criteria.


RESULTS
In all, 7.3% (5/68) of the patients developed IRS based on aforementioned criteria, a median of 56 days after initiation of antifungal therapy. This entity was associated with heart-lung transplantation (p=0.006), anti T-cell agent use (p=0.003), discontinuation of calcineurin inhibitor agent (p=0.002), and disseminated IA (p=0.069). In a risk assessment model, IRS developed in 0% (0/55) of the patients with none of the aforementioned factors, 28.6% (2/7) with one, 33.3% (1/3) with two, and in 1/1 patient with 3 factors (X(2) for trend p=0.0001). Three out of 5 patients with IRS died and 2 of 3 deaths in this group were due to chronic rejection.


CONCLUSIONS
Overall 7% of the lung transplant recipients with IA appear to develop an IRS-like entity. Clinically assessable factors can identify patients at risk for post-transplant IA-associated IRS. Deaths due to chronic rejection were significantly higher in patients with IRS than those without IRS.
University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: nis5@pitt.edu.
Nina
N
Singh
Jose F
JF
Suarez
Robin
R
Avery
Cornelia
C
Lass-Flörl
Christian
C
Geltner
Alessandro C
AC
Pasqualotto
G Marshall
GM
Lyon
Michelle
M
Barron
Shahid
S
Husain
Marilyn M
MM
Wagener
Jose G
JG
Montoya
D000328:Adult; D064591:Allografts; D005260:Female; D006084:Graft Rejection / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000401:mortality* / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
Aspergillosis; Immune reconstitution syndrome; Lung transplant