Danziger-Isakov Lara A, Worley Sarah, Arrigain Susana, Aurora Paul, Ballmann Manfred, Boyer Debra, Conrad Carol, Eichler Irmgard, Elidemir Okan, Goldfarb Samuel, Mallory George B, Michaels Marian G, Michelson Peter, Mogayzel Peter J, Parakininkas Daiva, Solomon Melinda, Visner Gary, Sweet Stuart, Faro Albert
Department of Pediatric Infectious Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Heart Lung Transplant. 2008 Jun;27(6):655-61. doi: 10.1016/j.healun.2008.03.010. Epub 2008 Apr 24.
Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized.
A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models.
Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8).
Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
儿童肺移植术后第一年肺部真菌感染（PFI）的危险因素、发病率和死亡率此前尚未得到明确描述。
1988年至2005年进行了一项回顾性多中心研究，该研究获得了北美和欧洲12个参与中心的机构批准。记录移植后第一年的数据。对数秩检验评估PFI与生存率之间的关联。通过Cox比例风险模型评估发生PFI的时间与危险因素之间的关联。
在555例接受移植的受试者中，58例（10.5%）在移植后第一年内发生了62例经证实（念珠菌、曲霉菌或其他）或可能（曲霉菌或其他）的PFI。发生PFI的受试者的平均年龄为14.0岁，未发生PFI的受试者为11.4岁（p<0.01）。经证实的疾病中，念珠菌和曲霉菌的检出率相同。将发生PFI的受试者（n = 58）与未发生PFI的受试者（n = 404）进行比较，移植前定植与PFI相关（风险比[HR] 2.0；95% CI 0.95至4.3，p = 0.067）。巨细胞病毒（CMV）不匹配、基于他克莫司的治疗方案和年龄>15岁与PFI相关（p<0.05）。PFI与任何高于A2级的既往排斥反应相关（HR 2.1；95% CI 1.2至3.6）。囊性纤维化、诱导治疗、移植时代和移植类型与PFI无关。PFI与12个月生存率降低独立相关（HR 3.9，95% CI 2.2至6.8）。
PFI的危险因素包括A2级排斥反应、反复急性排斥反应、CMV阳性供体、基于他克莫司的治疗方案和移植前定植。
