Fortún Jesús, Martín-Dávila Pilar, Moreno Santiago, De Vicente Emilio, Nuño Javier, Candelas Angel, Bárcena Rafael, García Miguel
Infectious Diseases Department and Liver Transplant Unit, Ramón y Cajal Hospital, Alcalá de Henares University, Madrid, Spain.
Liver Transpl. 2002 Nov;8(11):1065-70. doi: 10.1053/jlts.2002.36239.
Aspergillosis is a potential, severe, and usually early complication of liver transplantation. New promising strategies, such as detecting Aspergillus antigenemia, have been used for the diagnosis of aspergillosis in immunosuppressed patients, but the impact in solid organ transplantation is not well known. A case-control study in 260 adults who underwent liver transplantation from January 1994 to June 2000 was performed. A case was defined as any liver transplant recipient with a proven or probable diagnosis of invasive aspergillosis. Controls were defined as a liver transplant recipient without aspergillosis infection with a survival longer than two months after transplantation. Clinical and analytical variables, including Aspergillus antigenemia, were compared. A special analysis was performed in patients in whom late aspergillosis developed (after day 100 posttransplantation). Among 260 patients, invasive aspergillosis developed in 15 (5.6%). Median time from transplantation to aspergillosis in 13 patients with sufficient data for analysis was 126 days (range, 22 to 1117). Seven (54%) developed the infection after day 100 posttransplantation. Thirty-eight patients were used as controls. Antigenemia was available in nine of 13 cases and in 33 of 38 controls. By multivariate analysis, retransplantation (OR, 29.9 [95% CI, 2.1 to 425.1]), dialysis requirements after transplantation (OR, 24.5 [95% CI, 1.25 to 354]), and the presence of Aspergillus antigenemia in serum at any time point after transplantation (OR, 50.0 [95% CI, 3.56 to 650]) were independently associated to aspergillosis. In the subgroup of patients that developed late aspergillosis, cytomegalovirus infection (OR, 6.7 [95% CI, 1.0 to 42.5]) was the only independent factor associated. Hepatic and renal dysfunction predispose to Aspergillus infection in liver transplant recipients. Cytomegalovirus infection and increased immunosuppression favor invasive aspergillosis during the late posttransplantation period. Aspergillus antigenemia seems to be a good predictor of invasive aspergillosis.
曲霉病是肝移植潜在的、严重且通常较早出现的并发症。一些新的有前景的策略，如检测曲霉抗原血症，已被用于免疫抑制患者曲霉病的诊断，但在实体器官移植中的影响尚不清楚。对1994年1月至2000年6月接受肝移植的260名成年人进行了一项病例对照研究。病例定义为任何经证实或可能诊断为侵袭性曲霉病的肝移植受者。对照定义为无曲霉病感染且移植后存活超过两个月的肝移植受者。比较了包括曲霉抗原血症在内的临床和分析变量。对发生晚期曲霉病（移植后100天之后）的患者进行了特殊分析。在260名患者中，15名（5.6%）发生了侵袭性曲霉病。13名有足够数据进行分析的患者从移植到曲霉病的中位时间为126天（范围22至1117天）。7名（54%）在移植后100天之后发生感染。38名患者用作对照。13例病例中有9例可检测到抗原血症，38例对照中有33例可检测到。多因素分析显示，再次移植（比值比[OR]，29.9[95%可信区间（CI），2.1至425.1]）、移植后需要透析（OR，24.5[95%CI，1.25至354]）以及移植后任何时间点血清中存在曲霉抗原血症（OR，50.0[95%CI，3.56至650]）与曲霉病独立相关。在发生晚期曲霉病的患者亚组中，巨细胞病毒感染（OR，6.7[95%CI，1.0至42.5]）是唯一的独立相关因素。肝肾功能不全使肝移植受者易发生曲霉感染。巨细胞病毒感染和免疫抑制增加有利于移植后期发生侵袭性曲霉病。曲霉抗原血症似乎是侵袭性曲霉病的良好预测指标。
