Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

López‐Medrano, Francisco; Fernández‐Ruiz, Mario; Silva, J.T.; Carver, Peggy L.; Delden, Christian van; Merino, Esperanza; Perez-Saez, MJ; Montero, Milagro; Coussement, Julien; Mazzolin, M. de Abreu; Cervera, Carlos; Santos, Lídia; Sabé, N.; Scemla, Anne; Cordero, Elisa; Cruzado-Vega, Leónidas; Martín-Moreno, Paloma Leticia; Len, Óscar; Rudas, Edisson; León, Alfredo Ponce de; Arriola, M.; Lauzurica, Ricardo; David, M; González-Rico, Claudia; Henríquez-Palop, Fernando; Fortün, Jesús; Nucci, Márcio; Manuel, Oriol; Paño‐Pardo, José Ramón; Montejo, Miguel; Vena, Antonio; Sánchez‐Sobrino, Beatriz; Mazuecos, Auxiliadora; Pascual, Julio; Horcajada, Juan Pablo; Lecompte, T; Moreno, Asunción; Carratalà, J; Blanes, Marino; Hernandez, Dena G.; Hernández-Méndez, Erick Alejandro; Fariñas, María Carmen; Perelló, Manel; Andrés, Amado; Aguado, José María

doi:10.1016/j.cmi.2017.06.016

Cited by 26 publications

(37 citation statements)

References 26 publications

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“…The relatively greater prevalence of renal transplantation should be considered in preventive strategies aimed at reducing the burden of IFI. Although IFI is not a frequent complication in renal transplant recipients, it is associated with a considerable risk of mortality . In our study, the 1‐year cumulative probability of post‐IFI mortality in renal transplant recipients was 30.4%.…”

Section: Discussionmentioning

confidence: 54%

“…IFI has been shown to be associated with considerable mortality in immunocompromised patients . The 1‐year mortality of post‐transplant IFI has been reported to be 27%‐48% . Even among SOT types that are associated with a lower incidence of IFI, 1‐year mortality has been reported to be 19%‐40% and IFI is associated with considerable allograft loss (ie, 15%‐25% considering different fungal pathogens) .…”

Section: Introductionmentioning

confidence: 99%

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Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Hosseini-Moghaddam

Ouedraogo²,

Naylor³

et al. 2020

Transplant Infectious Dis

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Background Invasive fungal infection (IFI) in solid organ transplant (SOT) recipients is associated with significant morbidity and mortality. The long‐term probability of post‐transplant IFI is poorly understood. Methods We conducted a population‐based cohort study using linked administrative healthcare databases from Ontario, Canada, to determine the incidence rate; 1‐, 5‐, and 10‐year cumulative probabilities of IFI; and post‐IFI all‐cause mortality in SOT recipients from 2002 to 2016. We also determined post‐IFI, death‐censored renal allograft failure. Results We included 9326 SOT recipients (median follow‐up: 5.35 years). Overall, the incidence of IFI was 8.3 per 1000 person‐years. The 1‐year cumulative probability of IFI was 7.4% for lung, 5.4% for heart, 1.8% for liver, 1.2% for kidney‐pancreas, and 1.1% for kidney‐only allograft recipients. Lung transplant recipients had the highest incidence rate and 10‐year probability of IFI: 43.0 per 1000 person‐years and 26.4%, respectively. The 1‐year all‐cause mortality rate after IFI was 34.3%. IFI significantly increased the risk of mortality in SOT recipients over the entire follow‐up period (hazard ratio: 6.50, 95% CI: 5.69‐7.42). The 1‐year probability of death‐censored renal allograft failure after IFI was 9.8%. Conclusion Long‐term cumulative probability of IFI varies widely among SOT recipients. Lung transplantation was associated with the highest incidence of IFI with considerable 1‐year all‐cause mortality.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Hosseini-Moghaddam

Ouedraogo²,

Naylor³

et al. 2020

Transplant Infectious Dis

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“…The highest risk populations for invasive aspergillosis comprise chronic granulomatous disease, prolonged neutropenia, HSCT and heart, lung and pancreas organ transplantation [ 99 , 100 ]. Other lower risk patients include those with COPD [ 4 ], high dose corticosteroid treatment [ 101 ], lung cancer [ 102 ], liver cirrhosis [ 103 , 104 ], renal and liver transplantation [ 105 ], diabetes mellitus [ 106 ] and sepsis, especially in the ICU setting [ 107 ]. The global incidence of invasive aspergillosis was previously reported to be 200,000 cases with an associated mortality ranging from 30–80% [ 108 ], recently updated to >300,000 cases [ 20 ].…”

Section: Estimate Precisionmentioning

confidence: 99%

Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision

Bongomin

Gago

Oladele

et al. 2017

JoF

1,816

1,530

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Fungal diseases kill more than 1.5 million and affect over a billion people. However, they are still a neglected topic by public health authorities even though most deaths from fungal diseases are avoidable. Serious fungal infections occur as a consequence of other health problems including asthma, AIDS, cancer, organ transplantation and corticosteroid therapies. Early accurate diagnosis allows prompt antifungal therapy; however this is often delayed or unavailable leading to death, serious chronic illness or blindness. Recent global estimates have found 3,000,000 cases of chronic pulmonary aspergillosis, ~223,100 cases of cryptococcal meningitis complicating HIV/AIDS, ~700,000 cases of invasive candidiasis, ~500,000 cases of Pneumocystis jirovecii pneumonia, ~250,000 cases of invasive aspergillosis, ~100,000 cases of disseminated histoplasmosis, over 10,000,000 cases of fungal asthma and ~1,000,000 cases of fungal keratitis occur annually. Since 2013, the Leading International Fungal Education (LIFE) portal has facilitated the estimation of the burden of serious fungal infections country by country for over 5.7 billion people (>80% of the world’s population). These studies have shown differences in the global burden between countries, within regions of the same country and between at risk populations. Here we interrogate the accuracy of these fungal infection burden estimates in the 43 published papers within the LIFE initiative.

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“…17 In other studies, over half of IA episodes occurred over 1 year post-transplant. 18,19 In a retrospective study of 40 adult small bowel/multivisceral transplant (SmB/MV) recipients, 17% of recipients developed infection involving the lung(s) in the 30-day post-transplant period. Most of these were due to Pseudomonas aeruginosa.…”

Section: Considerations Impacting Differential Diagnosismentioning

confidence: 99%

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Dulek

Mueller

2019

Clinical Transplantation

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Pneumonia is a frequent infectious complication of solid organ transplantation (SOT). The occurrence of post-transplant pneumonia adversely impacts both graft and recipient survival, as well as the cost of care for SOT recipients. 1 Numerous micro-organisms can cause pneumonia in the SOT recipient with some etiologies resulting in self-limited infection and others causing significant morbidity and mortality. As a result of the varied clinical presentations and etiologies of pneumonia in SOT recipients, arriving at a specific microbiologic diagnosis can be challenging but is important for optimal care, especially with complicated or refractory pneumonias. In this section, the clinical presentation, differential diagnosis, diagnostic testing, and empiric antimicrobial treatment of pneumonia in SOT recipients are reviewed. Pathogen-specific sections within the AST ID Guidelines are referenced for further information regarding the diagnosis and treatment of specific pathogens that cause pneumonia in this vulnerable population. AbstractThese guidelines from the AST Infectious Diseases Community of Practice review the diagnosis and management of pneumonia in the post-transplant period. Clinical presentations and differential diagnosis for pneumonia in the solid organ transplant recipient are reviewed. A two-tier approach is proposed based on the net state of immunosuppression and the severity of presentation. With a lower risk of opportunistic, hospital-acquired, or exposure-specific pathogens and a non-severe presentation, empirical therapy may be initiated under close clinical observation. In all other patients, or those not responding to the initial therapy, a more aggressive diagnostic approach including sampling of tissue for microbiological and pathological testing is warranted. Given the broad range of potential pathogens, a microbiological diagnosis is often key for optimal care. Given the limited literature comparatively evaluating diagnostic approaches to pneumonia in the solid organ transplant recipient, much of the proposed diagnostic algorithm reflects clinical experience rather than evidencebased data. It should serve as a template which may be modified according to local needs. The same holds true for the suggested empiric therapies, which need to be adapted to the local resistance patterns. Further study is needed to comparatively evaluate diagnostic and empiric treatment strategies in SOT recipients. K E Y W O R D Sdiagnosis, pneumonia, transplantation

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Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation

Cited by 26 publications

References 26 publications

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Incidence and outcomes of invasive fungal infection among solid organ transplant recipients: A population‐based cohort study

Global and Multi-National Prevalence of Fungal Diseases—Estimate Precision

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

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