Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, Geneva, Switzerland.
Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona-IDIBAPS, Universitat de Barcelona, FungiCLINIC Research group (AGAUR), Barcelona, Spain.
BMC Infect Dis. 2021 Mar 24;21(1):296. doi: 10.1186/s12879-021-05958-3.
Invasive aspergillosis (IA) is a rare complication in solid organ transplant (SOT) recipients. Although IA has significant implications on graft and patient survival, data on diagnosis and management of this infection in SOT recipients are still limited.
Discussion of current practices and limitations in the diagnosis, prophylaxis, and treatment of IA and proposal of means of assessing treatment response in SOT recipients.
Liver, lung, heart or kidney transplant recipients have common as well as different risk factors to the development of IA, thus each category needs a separate evaluation. Diagnosis of IA in SOT recipients requires a high degree of awareness, because established diagnostic tools may not provide the same sensitivity and specificity observed in the neutropenic population. IA treatment relies primarily on mold-active triazoles, but potential interactions with immunosuppressants and other concomitant therapies need special attention.
Criteria to assess response have not been sufficiently evaluated in the SOT population and CT lesion dynamics, and serologic markers may be influenced by the underlying disease and type and severity of immunosuppression. There is a need for well-orchestrated efforts to study IA diagnosis and management in SOT recipients and to develop comprehensive guidelines for this population.
侵袭性曲霉病（IA）是实体器官移植（SOT）受者的一种罕见并发症。尽管 IA 对移植物和患者的生存有重大影响，但关于 SOT 受者中这种感染的诊断和管理的数据仍然有限。
讨论 IA 的诊断、预防和治疗的当前实践和局限性，并提出评估 SOT 受者治疗反应的方法。
肝、肺、心脏或肾脏移植受者有共同的和不同的 IA 发展危险因素，因此每个类别都需要单独评估。SOT 受者 IA 的诊断需要高度警惕，因为既定的诊断工具可能无法提供在中性粒细胞减少人群中观察到的相同敏感性和特异性。IA 的治疗主要依赖于具有霉菌活性的三唑类药物，但与免疫抑制剂和其他伴随治疗的潜在相互作用需要特别注意。
在 SOT 人群中，尚未充分评估评估反应的标准，CT 病变动态和血清标志物可能受到基础疾病以及免疫抑制的类型和严重程度的影响。需要协调一致的努力来研究 SOT 受者中的 IA 诊断和管理，并为这一人群制定综合指南。
