实体器官移植受者原发性机会性深部皮肤真菌感染的发生率和临床预测因素：一项多中心队列研究。

Incidence and clinical predictors of primary opportunistic deep cutaneous mycoses in solid organ transplant recipients: a multicenter cohort study.

机构信息

Section of Dermatology, University of Verona, 10032 Verona, Italy.

出版信息

Clin Transplant. 2010 May-Jun;24(3):328-33. doi: 10.1111/j.1399-0012.2009.01071.x. Epub 2009 Aug 27.

DOI:10.1111/j.1399-0012.2009.01071.x

PMID:19712084

Abstract

BACKGROUND

Primary opportunistic deep cutaneous fungal infections may cause significant morbidity and mortality in solid organ transplant recipients (OTR), but no data exist about their incidence, timing, and clinical predictors in a long-term follow-up.

PATIENTS AND METHODS

A series of 3293 consecutive OTR including 1991 kidney, 929 heart, and 373 liver transplant recipients were enrolled. Patients were regularly followed up since time at transplantation (mean 5.5 yr +/-5.9 SD) and primary opportunistic fungal infections registered. Persons-year at risk (PYs), incidence rates (IR), incidence rate ratios (IRR), and 95% confidence intervals were computed.

RESULTS

Twenty-two cases of deep cutaneous mycoses were detected, (IR 1.2 cases per 1000 PYs) after a mean follow-up time since transplantation of 2.5 yr +/- 2.0 SD (median 1.8 yr). Six patients had subsequent systemic involvement and three patients died of systemic dissemination. A higher risk for mycoses was observed in the first two yr after transplantation, (IRR 35.9, p < 0.0001), in renal transplant recipients (IRR 5.1 p = 0.030), and in patients transplanted after the age of 50 (IRR 11.5 p = 0.020).

CONCLUSIONS

Primary deep cutaneous opportunistic mycoses in OTR occur mainly in the first two yr after transplantation, in renal transplant recipients, and in older patients.

摘要

背景

原发性机会性深部皮肤真菌感染可导致实体器官移植受者（OTR）发生重大发病率和死亡率，但在长期随访中，尚无此类感染的发生率、时间和临床预测因素的数据。

患者和方法

共纳入 3293 例连续 OTR，包括 1991 例肾移植、929 例心脏移植和 373 例肝移植受者。自移植时间起（平均随访 5.5 年 +/-5.9 标准差），对患者进行定期随访，并登记原发性机会性真菌感染。计算了人年风险（PYs）、发病率（IR）、发病率比（IRR）和 95%置信区间。

结果

在平均 2.5 年 +/- 2.0 标准差（中位数 1.8 年）的随访后，发现 22 例深部皮肤真菌感染（IR 为每 1000 PYs 1.2 例）。6 例患者随后出现全身受累，3 例患者死于全身播散。移植后前 2 年（IRR 35.9，p < 0.0001）、肾移植受者（IRR 5.1，p = 0.030）和 50 岁以上患者（IRR 11.5，p = 0.020）的真菌感染风险更高。