title: Epidemiology, clinical characteristics, and outcome of invasive aspergillosis in renal transplant patients.
abstract: BACKGROUND
  Invasive aspergillosis (IA) has been considered an infrequent complication after renal transplantation. We aimed to evaluate the differences in clinical and epidemiologic characteristics of IA between renal and other types of transplantation.
  
  
  METHODS
  We reviewed all cases of solid organ transplant (SOT) recipients from Hospital Clinic at Barcelona, who had proven and probable IA, according to the EORTC/MSG criteria, between June 2003 and December 2010.
  
  
  RESULTS
  A total of 1762 transplants were performed. From this cohort, 27 cases of IA were diagnosed (1.5%): in 56% (15/27) liver, 33% (9/27) kidney, and 11% (3/27) combined transplant. The median onset time from renal and non-renal transplants to IA was 217 and 10 days, respectively (P < 0.001). There were 6 cases (22%) of late IA (>6 months), all in kidney recipients (P < 0.001). Renal transplant patients with IA more frequently had chronic lung disease (44% vs. 6%) and chronic heart failure (33% vs. 6%); they also had none of the classical risk factors for IA defined for liver transplantation (0% vs. 33%, P = 0.001), and therefore they did not receive antifungal prophylaxis (0% vs. 72%, P = 0.001). In 14/24 patients, serum galactomannan antigen was positive, and this related to higher mortality.
  
  
  CONCLUSIONS
  While classical risk factors described for IA in liver recipients are still valid, IA appears later in renal patients and is commonly associated with co-morbid conditions.
authors.affiliation: Department of Infectious Diseases, Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Hoyo
authors.forename: G
authors.initials: G
authors.lastname: Sanclemente
authors.forename: J Puig
authors.initials: JP
authors.lastname: de la Bellacasa
authors.forename: F
authors.initials: F
authors.lastname: Cofán
authors.forename: M J
authors.initials: MJ
authors.lastname: Ricart
authors.forename: M
authors.initials: M
authors.lastname: Cardona
authors.forename: J
authors.initials: J
authors.lastname: Colmenero
authors.forename: J
authors.initials: J
authors.lastname: Fernández
authors.forename: A
authors.initials: A
authors.lastname: Escorsell
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: C
authors.initials: C
authors.lastname: Cervera
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: chronic lung disease; galactomannan antigen; invasive aspergillosis; renal transplantation; risk factors; solid organ transplant