Hoyo I, Sanclemente G, de la Bellacasa J Puig, Cofán F, Ricart M J, Cardona M, Colmenero J, Fernández J, Escorsell A, Navasa M, Moreno A, Cervera C
Department of Infectious Diseases, Hospital Clinic of Barcelona - Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Barcelona, Spain.
Transpl Infect Dis. 2014 Dec;16(6):951-7. doi: 10.1111/tid.12301. Epub 2014 Oct 16.
Invasive aspergillosis (IA) has been considered an infrequent complication after renal transplantation. We aimed to evaluate the differences in clinical and epidemiologic characteristics of IA between renal and other types of transplantation.
We reviewed all cases of solid organ transplant (SOT) recipients from Hospital Clinic at Barcelona, who had proven and probable IA, according to the EORTC/MSG criteria, between June 2003 and December 2010.
A total of 1762 transplants were performed. From this cohort, 27 cases of IA were diagnosed (1.5%): in 56% (15/27) liver, 33% (9/27) kidney, and 11% (3/27) combined transplant. The median onset time from renal and non-renal transplants to IA was 217 and 10 days, respectively (P < 0.001). There were 6 cases (22%) of late IA (>6 months), all in kidney recipients (P < 0.001). Renal transplant patients with IA more frequently had chronic lung disease (44% vs. 6%) and chronic heart failure (33% vs. 6%); they also had none of the classical risk factors for IA defined for liver transplantation (0% vs. 33%, P = 0.001), and therefore they did not receive antifungal prophylaxis (0% vs. 72%, P = 0.001). In 14/24 patients, serum galactomannan antigen was positive, and this related to higher mortality.
While classical risk factors described for IA in liver recipients are still valid, IA appears later in renal patients and is commonly associated with co-morbid conditions.
侵袭性曲霉病（IA）一直被认为是肾移植后较少见的并发症。我们旨在评估肾移植与其他类型移植中IA的临床和流行病学特征差异。
我们回顾了2003年6月至2010年12月间巴塞罗那临床医院确诊或疑似IA的所有实体器官移植（SOT）受者病例，这些病例符合欧洲癌症研究与治疗组织/侵袭性真菌感染协作组（EORTC/MSG）标准。
共进行了1762例移植手术。在该队列中，诊断出27例IA（1.5%）：其中肝移植受者占56%（15/27），肾移植受者占33%（9/27），联合移植受者占11%（3/27）。肾移植和非肾移植至IA的中位发病时间分别为217天和10天（P < 0.001）。有6例（22%）为迟发性IA（>6个月），均为肾移植受者（P < 0.001）。患有IA的肾移植患者更常伴有慢性肺病（44%对6%）和慢性心力衰竭（33%对6%）；他们也没有肝移植中定义的IA经典危险因素（0%对33%，P = 0.001），因此未接受抗真菌预防（0%对72%，P = 0.001）。在24例患者中的14例中，血清半乳甘露聚糖抗原呈阳性，这与较高的死亡率相关。
虽然肝移植受者中描述的IA经典危险因素仍然有效，但IA在肾移植患者中出现较晚，且通常与合并症相关。
