title: Invasive aspergillosis after kidney transplant: case-control study.
abstract: BACKGROUND
  Transplant recipients are at risk for invasive aspergillosis (IA), associated with a significant mortality rate. Renal transplant-specific risk factors have not been established.
  
  
  METHODS
  Forty-one adult kidney transplant recipients diagnosed with proven or probable IA from 1995 through 2013 were identified by search of the computerized patient files in the University Hospitals Leuven. The control population in this 1:2 case-control study consisted of the 2 patients who received a kidney transplant immediately before and after each identified patient and did not develop IA (n = 82).
  
  
  RESULTS
  Leukopenia after kidney transplant increased the risk of IA among all patients (odds ratio [OR], 2.345 [95% confidence interval {CI}, 1.084-5.071]). For early-onset infection (ie, occurred during the first 3 months after transplant), a longer duration of renal replacement therapy pretransplant and the occurrence of leukopenia were risk factors (OR per year, 1.192 [95% CI, 1.006-1.413] and OR, 3.346 [95% CI, 1.063-10.527], respectively), whereas donor cytomegalovirus seropositivity increased the risk for late-onset IA (ie, occurred >3 months after transplant) (OR, 3.677 [95% CI, 1.388-9.743]). Twelve-week mortality rate was 39%. Disseminated infection, leukopenia, and the height of the serum galactomannan index were associated with an increased risk of death (hazard ratio [HR], 5.080 [95% CI, 1.740-14.830]; HR, 3.198 [95% CI, 1.183-8.649]; and HR, 1.371 [95% CI, 1.123-1.674], respectively).
  
  
  CONCLUSIONS
  Prolonged renal replacement therapy before kidney transplant increases the risk of IA early after transplant. The height of the serum galactomannan index predicts mortality.
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Line
authors: L
authors: Heylen
authors: Department of Hematology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Johan
authors: J
authors: Maertens
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Maarten
authors: M
authors: Naesens
authors: Department of Internal Medicine Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Eric
authors: E
authors: Van Wijngaerden
authors: Department of Medical Diagnostic Sciences, University Hospitals Leuven Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Katrien
authors: K
authors: Lagrou
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Bert
authors: B
authors: Bammens
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Kathleen
authors: K
authors: Claes
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Pieter
authors: P
authors: Evenepoel
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Björn
authors: B
authors: Meijers
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Dirk
authors: D
authors: Kuypers
authors: Department of Nephrology Department of Immunology and Microbiology, K.U. Leuven, Belgium.
authors: Ben
authors: B
authors: Sprangers
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D055744:Invasive Pulmonary Aspergillosis / Q000453:epidemiology* / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D066027:Transplant Recipients
keywords: hemodialysis; invasive aspergillosis; kidney transplant; mortality; risk factors