Neofytos D, Fishman J A, Horn D, Anaissie E, Chang C-H, Olyaei A, Pfaller M, Steinbach W J, Webster K M, Marr K A
School of Medicine, Division of Infectious Diseases, The Johns Hopkins University, Baltimore, Maryland 21205, USA.
Transpl Infect Dis. 2010 Jun;12(3):220-9. doi: 10.1111/j.1399-3062.2010.00492.x. Epub 2010 Jan 25.
Contemporary epidemiology and outcomes of invasive fungal infections (IFIs) in solid organ transplant (SOT) recipients are not well described. From March 2004 through September 2007, proven and probable IFIs were prospectively identified in 17 transplant centers in the United States. A total 429 adult SOT recipients with 515 IFIs were identified; 362 patients received a single and 67 patients received >or=2 organs. Most IFIs were caused by Candida species (59.0%), followed by Aspergillus species (24.8%), Cryptococcus species (7.0%), and other molds (5.8%). Invasive candidiasis (IC) was the most frequently observed IFI in all groups, except for lung recipients where invasive aspergillosis (IA) was the most common IFI (P<0.0001). Almost half of IC cases in liver, heart, and lung transplant recipients occurred during the first 100 days post transplant. Over half of IA cases in lung recipients occurred >1 year post transplant. Overall 12-week mortality was 29.6%; liver recipients had the highest mortality (P=0.05). Organ damage, neutropenia, and administration of corticosteroids were predictors of death. These results extend our knowledge on the epidemiology of IFI in SOT recipients, emphasizing the occurrence of IC early after non-lung transplant, and late complications with molds after lung transplant. Overall survival appears to have improved compared with historical reports.
实体器官移植（SOT）受者侵袭性真菌感染（IFI）的当代流行病学和转归情况尚未得到充分描述。2004年3月至2007年9月期间，在美国17个移植中心对确诊和疑似IFI进行了前瞻性识别。共识别出429例患有515次IFI的成年SOT受者；362例患者接受了单个器官移植，67例患者接受了≥2个器官移植。大多数IFI由念珠菌属引起（59.0%），其次是曲霉属（24.8%）、隐球菌属（7.0%）和其他霉菌（5.8%）。侵袭性念珠菌病（IC）是所有组中最常观察到的IFI，但肺移植受者中侵袭性曲霉病（IA）是最常见的IFI除外（P<0.0001）。肝、心和肺移植受者中近一半的IC病例发生在移植后的前100天内。肺移植受者中超过一半的IA病例发生在移植后1年以上。总体12周死亡率为29.6%；肝移植受者的死亡率最高（P=0.05）。器官损害、中性粒细胞减少和使用皮质类固醇是死亡的预测因素。这些结果扩展了我们对SOT受者IFI流行病学的认识，强调了非肺移植后早期IC的发生以及肺移植后霉菌的晚期并发症。与历史报告相比，总体生存率似乎有所提高。
