Schaenman J M, Rosso F, Austin J M, Baron E J, Gamberg P, Miller J, Oyer P E, Robbins R C, Montoya J G
Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California 94305, USA.
Transpl Infect Dis. 2009 Apr;11(2):112-21. doi: 10.1111/j.1399-3062.2009.00364.x.
Although invasive candidiasis (IC) causes significant morbidity and mortality in patients who undergo heart, lung, or heart-lung transplantation, a systematic study in a large cohort of thoracic organ transplant recipients has not been reported to date. Clinical and microbiological data were reviewed for 1305 patients who underwent thoracic organ transplantation at Stanford University Medical Center between 1980 and 2004. We identified and analyzed 76 episodes of IC in 68 patients (overall incidence 5.2% per patient).The incidence of IC was higher in lung (LTx) and heart-lung transplant (HLTx) recipients as compared with heart transplant (HTx) recipients (risk ratio [RR] 1.7, 95% confidence interval [CI] 1.1-2.7).The incidence of IC decreased over time in all thoracic organ transplant recipients, decreasing from 6.1% in the 1980-1986 time period to 2.1% in the 2001-2004 era in the HTx recipients, and from 20% in the 1980-1986 period to 1.8% in the 2001-2004 period in the LTx and HLTx recipients.The most common site of infection differed between the HTx and LTx cohorts, with bloodstream or disseminated disease in the former and tracheobronchitis in the latter. IC in the first year after transplant was significantly associated with death in both HTx (RR 2.9, 95% CI 1.8-4.6, P=0.001) and LTx and HLTx patients (RR 3.0, 95% CI 1.9-4.6, P<0.001). The attributable mortality from IC decreased during the 25-year period of observation, from 36% to 20% in the HTx recipients and from 39% to 15% in the LTx and HLTx recipients. There were a significant number of cases caused by non-albicans Candida species in all patients, with a trend toward higher mortality in the HTx group. In conclusion, the incidence and attributable mortality of IC in thoracic organ transplant recipients has significantly declined over the past 25 years.The use of newer antifungal agents for prophylaxis and treatment, the decrease in the incidence of cytomegalovirus disease, and the use of more selective immunosuppression, among other factors, may have been responsible for this change.
尽管侵袭性念珠菌病（IC）在接受心脏、肺或心肺移植的患者中会导致显著的发病率和死亡率，但迄今为止，尚未有对大量胸器官移植受者进行的系统性研究报告。我们回顾了1980年至2004年间在斯坦福大学医学中心接受胸器官移植的1305例患者的临床和微生物学数据。我们识别并分析了68例患者中的76次IC发作（每位患者的总体发病率为5.2%）。与心脏移植（HTx）受者相比，肺移植（LTx）和心肺移植（HLTx）受者的IC发病率更高（风险比[RR]为1.7，95%置信区间[CI]为1.1 - 2.7）。在所有胸器官移植受者中，IC的发病率随时间下降，HTx受者中从1980 - 1986年期间的6.1%降至2001 - 2004年期间的2.1%，LTx和HLTx受者中从1980 - 1986年期间的20%降至2001 - 2004年期间的1.8%。HTx和LTx队列中最常见的感染部位不同，前者为血流感染或播散性疾病，后者为气管支气管炎。移植后第一年的IC在HTx（RR 2.9，95% CI 1.8 - 4.6，P = 0.001）以及LTx和HLTx患者中（RR 3.0，95% CI 1.9 - 4.6，P < 0.001）均与死亡显著相关。在25年的观察期内IC所致的归因死亡率下降，HTx受者中从36%降至20%，LTx和HLTx受者中从39%降至15%。所有患者中由非白色念珠菌属引起的病例数量显著，HTx组有更高死亡率的趋势。总之，在过去25年中，胸器官移植受者中IC的发病率和归因死亡率显著下降。使用更新的抗真菌药物进行预防和治疗、巨细胞病毒疾病发病率的降低以及使用更具选择性的免疫抑制等因素可能是导致这一变化的原因。
