title: Invasive aspergillosis among heart transplant recipients: a 24-year perspective.
abstract: BACKGROUND
  Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem.
  
  
  METHODS
  We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution.
  
  
  RESULTS
  Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09).
  
  
  CONCLUSIONS
  In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid. Electronic address: pmunoz@micro.hggm.es.
authors.forename: Patricia
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid.
authors.forename: Ines
authors.initials: I
authors.lastname: Cerón
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid.
authors.forename: Maricela
authors.initials: M
authors.lastname: Valerio
authors.affiliation: Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Palomo
authors.affiliation: Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Villa
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid.
authors.forename: Alia
authors.initials: A
authors.lastname: Eworo
authors.affiliation: Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Yáñez
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid.
authors.forename: Jesús
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bouza
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D055744:Invasive Pulmonary Aspergillosis / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents
keywords: Aspergillus spp; anti-fungal prophylaxis; heart transplantation; invasive aspergillosis