Invasive aspergillosis in kidney transplant recipients: a cohort study.
OBJECTIVE
Fungal infections represent 5% of infections in renal transplant recipients. Candidiasis is the most frequent, followed by aspergillosis and cryptococcosis. Invasive aspergillosis is severe and has a poor prognosis, but recent series focused on outcomes are scarce in the literature. We analyzed invasive aspergillosis cases in a cohort of kidney transplant recipients and suggest that prognosis is improved with early diagnosis and treatment.


METHODS
A retrospective study was performed in all kidney transplant undertaken in our hospital from January 1979 to December 2012. The incidence and characteristics of invasive aspergillosis were collected from kidney transplant prospective registry and microbiology laboratory.


RESULTS
We found 7 invasive aspergillosis cases (6 probable invasive aspergillosis and 1 possible invasive aspergillosis, according to EORTC/IFICG criteria); cumulative incidence 0.78% (7/891). The median posttransplant time until the disease onset was 3.03 months (interquartile range, 2.4-3.2 months), with a mean age of 56 years at the time of diagnosis. Six patients were male. Four patients had previous pulmonary disease. Six patients had received induction therapy (5 anti-IL2R antibodies, 1 with antilymphocytic antibodies). Two patients had received extra immunosuppression (1 with thymoglobulin to treat an acute rejection and the other 1 had a lymphoproliferative disorder and was on chemotherapy). Six patients were on calcineurin inhibitors at the time of diagnosis. Aspergillus fumigatus was the specimen most commonly isolated (6 cases). Six patients had a bacterial coinfection and 1 had a cytomegalovirus coinfection. All patients were treated with antifungal agents; 3 of which received voriconazole. Four patients satisfactorily resolved the episode and 3 died.


CONCLUSIONS
Invasive aspergillosis incidence is low in kidney transplant although potentially lethal. We observed an acceptable survival of patients analyzed, better than usually reported. A high index of suspicion is essential to get an early diagnosis and start treatment.
Department of Nephrology, Hospital del Mar, Barcelona, Spain.
Maria José
MJ
Pérez-Sáez
Marisa
M
Mir
Maria Milagro
MM
Montero
Marta
M
Crespo
Núria
N
Montero
Julià
J
Gómez
Juan Pablo
JP
Horcajada
Julio
J
Pascual
D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000145:classification / Q000187:drug effects / Q000472:pathogenicity*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology* / Q000401:mortality; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
D000935:Antifungal Agents; D007166:Immunosuppressive Agents