Clinical risk factors for invasive aspergillosis in lung transplant recipients: Results of an international cohort study.

Détails

ID Serval
serval:BIB_3C0C3F56A882
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Clinical risk factors for invasive aspergillosis in lung transplant recipients: Results of an international cohort study.
Périodique
The Journal of heart and lung transplantation
Auteur⸱e⸱s
Aguilar C.A., Hamandi B., Fegbeutel C., Silveira F.P., Verschuuren E.A., Ussetti P., Chin-Hong P.V., Sole A., Holmes-Liew C., Billaud E.M., Grossi P.A., Manuel O., Levine D.J., Barbers R.G., Hadjiliadis D., Singer L.G., Husain S.
ISSN
1557-3117 (Electronic)
ISSN-L
1053-2498
Statut éditorial
Publié
Date de publication
10/2018
Peer-reviewed
Oui
Volume
37
Numéro
10
Pages
1226-1234
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
Invasive aspergillosis (IA) is a frequent complication in lung transplant recipients (LTRs). Clinical risk factors for IA have not been fully characterized, especially in the era of extensive anti-fungal prophylaxis. The primary objective of this study was to evaluate the clinical risk factors associated with IA in LTRs. The secondary objective was to assess the mortality in LTRs who had at least 1 episode of IA compared with LTRs who never had experienced IA.
We conducted an international, multicenter, retrospective cohort study of 900 consecutive adults who received lung transplants between 2005 and 2008 with 4years of follow-up. Risk factors associated with IA were identified using univariate and multiple regression Cox proportional hazards models.
Anti-fungal prophylaxis was administered to 61.7% (555 of 900) of patients, and 79 patients developed 115 episodes of IA. The rate to development of the first episode was 29.6 per 1,000 person-years. Aspergillus fumigatus was the most common species isolated (63% [72 of 115 episodes]). Through multivariate analysis, significant risk factors identified for IA development were single lung transplant (hazard ratio, 1.84; 95% confidence interval, 1.09-3.10; p = 0.02,) and colonization with Aspergillus at 1 year post-transplantation (hazard ratio, 2.11; 95% confidence interval, 1.28-3.49; p = 0.003,). Cystic fibrosis, pre-transplant colonization with Aspergillus spp, and use of anti-fungal prophylaxis were not significantly associated with the development of IA. Time-dependent analysis showed IA was associated with higher mortality rates.
Incidence of IA remains high in LTRs. Single-lung transplant and airway colonization with Aspergillus spp. within 1 year post-transplant were significantly associated with IA.
Mots-clé
Adolescent, Adult, Aged, Antifungal Agents/therapeutic use, Aspergillus fumigatus, Cohort Studies, Female, Follow-Up Studies, Humans, Invasive Pulmonary Aspergillosis/etiology, Invasive Pulmonary Aspergillosis/mortality, Invasive Pulmonary Aspergillosis/prevention & control, Lung Transplantation, Male, Middle Aged, Postoperative Complications/etiology, Postoperative Complications/mortality, Postoperative Complications/prevention & control, Proportional Hazards Models, Retrospective Studies, Risk Factors, Survival Analysis, Young Adult, Aspergillus spp, anti-fungal prophylaxis, invasive aspergillosis, lung transplant recipient, single-lung transplant
Pubmed
Web of science
Création de la notice
04/09/2018 11:59
Dernière modification de la notice
30/01/2020 7:20
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