Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children's Hospital of Philadelphia, Pennsylvania.
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):219-225. doi: 10.1093/jpids/pix041.
Solid organ transplant (SOT) recipients are at risk for invasive fungal disease (IFD). Data on IFD burden in pediatric patients are limited. We aimed to determine the incidence and outcome of IFD in a large cohort of pediatric patients who underwent SOT.
A single-center cohort of pediatric patients who underwent SOT between 2000 and 2013 was assembled retrospectively. The patients were followed for 180 days after transplant or until death to determine the presence or absence of IFD. The 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria were used to define IFD as proven or probable. The incidence of IFD, all-cause mortality rate, and case-fatality rate at 180 days were calculated.
Among 584 pediatric patients who underwent SOT, 13 patients sustained 14 episodes of IFD (candidiasis, aspergillosis, and mucormycosis). The overall incidence was 2.2% (14.3 IFD events per 100000 patient-days). The IFD rates according to transplant type were 12.5% (1 of 8) (heart/lung), 11.4% (4 of 35) (lung), 4.7% (8 of 172) (liver), 0% (0 of 234) (kidney), and 0% (0 of 135) (heart). Three patients with IFD (2 lung and 1 heart/lung) died, and all these deaths were deemed likely attributable to the IFD; the case-fatality rate was 21.4% (3 of 14).
The overall incidence of IFD in these pediatric SOT recipients was low but varied across transplant type, with heart/lung and lung recipients having the highest IFD rate. Given the attributable case-fatality rate, the risk of death resulting from IFD is potentially high. More data on groups at higher risk, such as lung transplant recipients, are needed to guide targeted antifungal prophylaxis.
实体器官移植（SOT）受者存在侵袭性真菌病（IFD）的风险。关于儿科患者 IFD 负担的数据有限。我们旨在确定在接受 SOT 的大量儿科患者中 IFD 的发生率和结局。
回顾性收集了 2000 年至 2013 年间接受 SOT 的儿科患者的单中心队列。在移植后 180 天或直至死亡时对患者进行随访，以确定是否存在 IFD。使用 2008 年欧洲癌症研究与治疗组织/侵袭性真菌病感染合作组和美国国家过敏与传染病研究所霉菌病研究组共识组标准定义 IFD 为确诊或拟诊。计算 IFD 的发生率、全因死亡率和 180 天病死率。
在 584 名接受 SOT 的儿科患者中，13 名患者发生了 14 例 IFD（念珠菌病、曲霉菌病和毛霉菌病）。总体发生率为 2.2%（每 100000 患者天发生 14.3 例 IFD 事件）。根据移植类型，IFD 发生率分别为 12.5%（8/8）（心/肺）、11.4%（4/35）（肺）、4.7%（8/172）（肝）、0%（0/234）（肾）和 0%（0/135）（心）。3 例 IFD 患者（2 例肺，1 例心/肺）死亡，所有这些死亡均可能归因于 IFD；病死率为 21.4%（3/14）。
这些儿科 SOT 受者的 IFD 总体发生率较低，但在移植类型上有所不同，心/肺和肺移植受者的 IFD 发生率最高。鉴于归因于 IFD 的病死率，IFD 导致死亡的风险可能很高。需要更多关于高危人群（如肺移植受者）的数据，以指导靶向抗真菌预防。
