Efficacy and Tolerance of Different Types of Prophylaxis for Prevention of Early Aspergillosis After Heart Transplantation

Martin, M.; Rivas, Raquel Marzoa; Caballero, Eduardo; Cancela, Zulaika Grille; Fernández, Carlos; Solla, María Marta; Pedrosa, Victor Breno; Fernández, José Ángel Rodríguez; Herrera, José María; Castro‐Beiras, Alfonso; Crespo-Leiro, María G.

doi:10.1016/j.transproceed.2010.08.013

Cited by 14 publications

(16 citation statements)

References 9 publications

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“…1,2 Comparison to other studies is limited, as incidence rates were inconsistently reported and the reports included heterogeneous SOT populations. 6,8,13 Although the incidence of IFD was relatively low in our cohort of HT patients, those with IFD had a crude 5-fold increase in mortality compared to patients without IFD. Fifty-seven percent of cases (13 of 23) occurred within the first 3 months after HT, including 4 cases of fatal mediastinitis from Candida or Aspergillus species.…”

Section: Discussionmentioning

confidence: 70%

“…Two studies have analyzed the impact of empirical anti-fungal prophylaxis in HT patients. 6,8 Paniagua Martin and colleagues retrospectively compared no fungal prophylaxis to universal prophylaxis with either itraconazole capsules or inhaled amphotericin for prevention of aspergillosis during the 3 months after HT. 6 Subjects were not stratified according to risk of IFD.…”

Section: Discussionmentioning

confidence: 99%

“…6,8 Paniagua Martin and colleagues retrospectively compared no fungal prophylaxis to universal prophylaxis with either itraconazole capsules or inhaled amphotericin for prevention of aspergillosis during the 3 months after HT. 6 Subjects were not stratified according to risk of IFD. The investigators showed a reduction in the incidence of pulmonary aspergillosis with prophylactic itraconazole (1.4%) or inhaled amphotericin (0%) when compared with no fungal prophylaxis (5%).…”

Section: Discussionmentioning

confidence: 99%

“…Surveillance studies of heart and other solid-organ transplant (SOT) recipients have suggested an overall IFD incidence of 1% to 12% with an attributable mortality of between 35% and 75%. 1–7 Some studies have explored empirical anti-fungal prophylaxis after HT, 6,8 but data regarding IFD incidence, timing and risk factors in the HT population are very limited. In this study, we sought to estimate IFD incidence and identify IFD risk factors in a cohort of HT patients to identify patients who may benefit from anti-fungal prophylaxis.…”

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confidence: 99%

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Risk factors for invasive fungal disease in heart transplant recipients

Rabin

Givertz²,

Couper

et al. 2015

The Journal of Heart and Lung Transplantation

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BACKGROUND Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbid and potentially fatal complication. METHODS We performed a retrospective cohort study to evaluate the incidence and risk factors for IFD in HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probable IFD according to current consensus definitions of the European Organization for Research and Treatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Cox proportional hazards models to determine IFD risk factors. RESULTS Three hundred sixty patients underwent HT during the study period. The most common indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23 (6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100 person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most common etiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidence of 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p = 0.01) and the addition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid induction therapy (HR 2.7, 95% CI 1.1 to 6.2, p = 0.02) were independently associated with an increased risk of IFD. CONCLUSIONS IFD incidence was greatest within the first 3 months post-HT, largely reflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patients receiving additional induction immunosuppression or delayed chest closure were at increased risk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HT recipients.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk factors for invasive fungal disease in heart transplant recipients

Rabin

Givertz²,

Couper

et al. 2015

The Journal of Heart and Lung Transplantation

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“…Reported mortality rates among HTx recipients range from 0% to 67% [1,2,7–9] and it is unclear if outcomes have improved. Moreover, the role of antifungal prophylaxis remains controversial [1,2,7,10]. The objective of this study was to describe the epidemiology, clinical manifestations, and outcomes of IA among HTx recipients during the era of an expanded antifungal armamentarium at a center that did not employ antifungal prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

Invasive aspergillosis among heart transplant recipients is rare but causes rapid death due to septic shock and multiple organ dysfunction syndrome

Shields

Nguyen

Shullo

et al. 2012

Scandinavian Journal of Infectious Diseases

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Between 2000 and 2011, proven or probable invasive aspergillosis (IA) was diagnosed in 1.7% (8/455) of heart transplant (HTx) recipients at our center, in the absence of antifungal prophylaxis. All patients had invasive pulmonary infections and 75% (6/8) were diagnosed during 2 separate 3-month periods. Cases were notable for their association with septic shock and multiple organ dysfunction syndrome (MODS) (75%, 6/8 each), non-specific clinical and radiographic findings, and rapid mortality despite mould-active antifungal therapy (88%, 7/8; occuring at a median 11 days after diagnosis). All patients had predisposing conditions known to be risk factors for IA. For patients with early IA (within 90 days of HTx), conditions included hemodialysis, thoracic re-operation, and the presence of another case in the institution within the preceding 3 months. For late-onset IA, conditions included hemodialysis and receipt of augmented immunosuppression. Clinicians should suspect IA in HTx recipients with risk factors who present with non-specific and unexplained respiratory syndromes, including those in septic shock and MODS, and institute prompt antifungal therapy without waiting for the results of cultures or other diagnostic tests.

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Prevention of Fungal Disease

Huprikar

Wingard

2019

Principles and Practice of Transplant Infectious Diseases

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Efficacy and Tolerance of Different Types of Prophylaxis for Prevention of Early Aspergillosis After Heart Transplantation

Cited by 14 publications

References 9 publications

Risk factors for invasive fungal disease in heart transplant recipients

Risk factors for invasive fungal disease in heart transplant recipients

Invasive aspergillosis among heart transplant recipients is rare but causes rapid death due to septic shock and multiple organ dysfunction syndrome

Prevention of Fungal Disease

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