Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study.
BACKGROUND
Invasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy.


METHODS
We retrospectively collected all cases of KTR-associated IA occurring at Necker Enfants Malades Hospital, Paris, from 2003 to 2013. These cases were compared with a group of controls (1:3) who were matched by age, year of kidney transplantation, and sex. The characteristics of IA were also studied.


RESULTS
Sixteen patients developed IA after KTR. Most IA cases were limited to the lungs (81.3%), with mild respiratory symptoms in only 53% of the patients. The patients were administered voriconazole (n = 15, 94%) and/or posaconazole (n = 2, 13%). The 12-week and 1-year postinfection survival rates were 94% and 81%, respectively. Compared with the controls (n = 46), patients and death-censored graft survivals rates were significantly lower after IA (P= 0.017 and 0.001, respectively). In the patients with IA, the occurrences of cardiovascular diseases before transplantation (P< 0.0001), delayed graft function (P< 0.0001), and infectious complications (0.0018) were significantly more frequent.


CONCLUSIONS
Even with voriconazole therapy, the prognosis of patients with IA after kidney transplantation is still poor. When the patients survive to IA, they have a high risk of graft loss.
Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre d'Infectiologie Necker Pasteur, Paris, France.
Anne-Claire
AC
Desbois
Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
Sylvain
S
Poiree
Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France.
Renaud
R
Snanoudj
Service de Mycologie-Parasitologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France.
Marie-Elisabeth
ME
Bougnoux
Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France.
Rebecca
R
Sberro-Soussan
Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre d'Infectiologie Necker Pasteur, Paris, France.; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
Fanny
F
Lanternier
Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France.
Christophe
C
Legendre
Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre d'Infectiologie Necker Pasteur, Paris, France.; Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris, France.
Olivier
O
Lortholary
Service de Néphrologie et Transplantation Adulte, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France.
Anne
A
Scemla