Pérez-Sáez Maria José, Mir Marisa, Montero Maria Milagro, Crespo Marta, Montero Núria, Gómez Julià, Horcajada Juan Pablo, Pascual Julio
Department of Nephrology, Hospital del Mar, Barcelona, Spain.
Exp Clin Transplant. 2014 Apr;12(2):101-5.
Fungal infections represent 5% of infections in renal transplant recipients. Candidiasis is the most frequent, followed by aspergillosis and cryptococcosis. Invasive aspergillosis is severe and has a poor prognosis, but recent series focused on outcomes are scarce in the literature. We analyzed invasive aspergillosis cases in a cohort of kidney transplant recipients and suggest that prognosis is improved with early diagnosis and treatment.
A retrospective study was performed in all kidney transplant undertaken in our hospital from January 1979 to December 2012. The incidence and characteristics of invasive aspergillosis were collected from kidney transplant prospective registry and microbiology laboratory.
We found 7 invasive aspergillosis cases (6 probable invasive aspergillosis and 1 possible invasive aspergillosis, according to EORTC/IFICG criteria); cumulative incidence 0.78% (7/891). The median posttransplant time until the disease onset was 3.03 months (interquartile range, 2.4-3.2 months), with a mean age of 56 years at the time of diagnosis. Six patients were male. Four patients had previous pulmonary disease. Six patients had received induction therapy (5 anti-IL2R antibodies, 1 with antilymphocytic antibodies). Two patients had received extra immunosuppression (1 with thymoglobulin to treat an acute rejection and the other 1 had a lymphoproliferative disorder and was on chemotherapy). Six patients were on calcineurin inhibitors at the time of diagnosis. Aspergillus fumigatus was the specimen most commonly isolated (6 cases). Six patients had a bacterial coinfection and 1 had a cytomegalovirus coinfection. All patients were treated with antifungal agents; 3 of which received voriconazole. Four patients satisfactorily resolved the episode and 3 died.
Invasive aspergillosis incidence is low in kidney transplant although potentially lethal. We observed an acceptable survival of patients analyzed, better than usually reported. A high index of suspicion is essential to get an early diagnosis and start treatment.
真菌感染占肾移植受者感染的5%。念珠菌病最为常见，其次是曲霉病和隐球菌病。侵袭性曲霉病病情严重且预后较差，但近期文献中关于其结局的系列报道较少。我们分析了一组肾移植受者中的侵袭性曲霉病病例，并表明早期诊断和治疗可改善预后。
对1979年1月至2012年12月在我院进行的所有肾移植手术进行回顾性研究。从肾移植前瞻性登记处和微生物实验室收集侵袭性曲霉病的发病率和特征。
我们发现7例侵袭性曲霉病病例（根据欧洲癌症研究与治疗组织/侵袭性真菌感染协作组标准，6例为可能的侵袭性曲霉病，1例为可能的侵袭性曲霉病）；累积发病率为0.78%（7/891）。疾病发作的移植后中位时间为3.03个月（四分位间距，2.4 - 3.2个月），诊断时的平均年龄为56岁。6例患者为男性。4例患者既往有肺部疾病。6例患者接受了诱导治疗（5例使用抗IL2R抗体，1例使用抗淋巴细胞抗体）。2例患者接受了额外的免疫抑制治疗（1例使用胸腺球蛋白治疗急性排斥反应，另1例患有淋巴增殖性疾病且正在接受化疗）。6例患者在诊断时正在使用钙调神经磷酸酶抑制剂。烟曲霉是最常分离出的标本（6例）。6例患者有细菌合并感染，1例有巨细胞病毒合并感染。所有患者均接受了抗真菌药物治疗；其中3例接受了伏立康唑治疗。4例患者病情得到满意缓解，3例死亡。
侵袭性曲霉病在肾移植中的发病率较低，尽管具有潜在致死性。我们观察到所分析患者的生存率尚可，优于通常报道的情况。高度的怀疑指数对于早期诊断和开始治疗至关重要。
