Epidemiology, clinical characteristics, and outcome of invasive aspergillosis in renal transplant patients

Hoyo, Irma; Sanclemente, G.; Bellacasa, Jorge Puig de la; Cofan, Frederic; Ricart, M.J.; Cardona, M.; Colmenero, Jordi; Fernández, J.; Escorsell, Àngels; Navasa, Miquel; Moreno, Asunción; Cervera, Carlos

doi:10.1111/tid.12301

Cited by 33 publications

(31 citation statements)

References 34 publications

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“…3,10 Thus, despite an increase in transplants among elderly and highly immunized patients, no IA breakthrough was observed. Although early IA was described in half of the IA cases in solid organ transplantation (SOT) 10 years ago, 3,11 our study, in accordance with other recent studies, 4,6 demonstrated that late IA (>6 months after transplantation) is more frequent in KTR, occurring in 69% of patients.…”

Section: Discussionsupporting

confidence: 90%

“…We found that the global mortality rate was still high: the overall mortality rate was 56.3% (9 of 16 patients) compared with 70% in 2 retrospective studies without voriconazole. 3,4 However, the 12-week mortality rate was lower than that reported in other studies of patients receiving voriconazole (ie, 6% in our study compared to 19% in the recent study of Heylen et al 6 and 34.4% among SOT recipients. 7 Similarly, in the Veroux et al 10 study, none of 4 patients receiving voriconazole died within 13 months after IA.…”

Section: Discussioncontrasting

confidence: 59%

“…2 It has been associated with a high mortality rate, ranging from 40% to 70%. 3,4 After 2002, voriconazole, a broad-spectrum triazole that is active against Aspergillus species, and improved diagnostic tools (eg, galactomannan antigen and Aspergillus PCR) have dramatically improved the prognosis for the patients with IA, 5 particularly for hematological neutropenic patients. Two recently published studies provided discordant information regarding IA prognosis in KTR.…”

mentioning

confidence: 99%

“…Two recently published studies provided discordant information regarding IA prognosis in KTR. 4,6 Heylen et al 6 reported a decrease in the 12 weeks mortality after IA diagnosis, from 73% before 2003 to 19% after 2003. However, in the study of Hoyo et al, 4 still 70% (7/10) of KTR with IA occurring after 2003 died.…”

mentioning

confidence: 99%

“…4,6 Heylen et al 6 reported a decrease in the 12 weeks mortality after IA diagnosis, from 73% before 2003 to 19% after 2003. However, in the study of Hoyo et al, 4 still 70% (7/10) of KTR with IA occurring after 2003 died. No study has specifically studied both short- and long-term survivals after IA, nor has compared it with the survival of patients without IA.…”

mentioning

confidence: 99%

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Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study

Poirée

Snanoudj

Bougnoux

et al. 2016

Transplantation Direct

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BackgroundInvasive aspergillosis (IA) is a major cause of invasive fungal infection in kidney transplant recipients (KTR), and it has a high mortality rate. However, its impact on patients and graft survival has not been well defined in the current era of voriconazole first-line therapy.MethodsWe retrospectively collected all cases of KTR-associated IA occurring at Necker Enfants Malades Hospital, Paris, from 2003 to 2013. These cases were compared with a group of controls (1:3) who were matched by age, year of kidney transplantation, and sex. The characteristics of IA were also studied.ResultsSixteen patients developed IA after KTR. Most IA cases were limited to the lungs (81.3%), with mild respiratory symptoms in only 53% of the patients. The patients were administered voriconazole (n = 15, 94%) and/or posaconazole (n = 2, 13%). The 12-week and 1-year postinfection survival rates were 94% and 81%, respectively. Compared with the controls (n = 46), patients and death-censored graft survivals rates were significantly lower after IA (P = 0.017 and 0.001, respectively). In the patients with IA, the occurrences of cardiovascular diseases before transplantation (P < 0.0001), delayed graft function (P < 0.0001), and infectious complications (0.0018) were significantly more frequent.ConclusionsEven with voriconazole therapy, the prognosis of patients with IA after kidney transplantation is still poor. When the patients survive to IA, they have a high risk of graft loss.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 59%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study

Poirée

Snanoudj

Bougnoux

et al. 2016

Transplantation Direct

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Consideration of difficulties and exit strategies in a case of face allotransplantation resulting in failure

Özkan

Doğan

et al. 2017

Microsurgery

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We describe the first rescue procedure in a case of total face allotransplantation. The recipient was a 54-year-old man with severe disfigurement of the entire face following an accidental gunshot injury 5 years previously. The large defect included the maxilla, mandible, and mid-face. Full face procurement was performed from a multiorgan cadaveric donor and was allotransplanted to the recipient. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last three of these. Although the early postoperative period was uneventful, squamous cell carcinoma developed in the upper and lower extremities in the fifth postoperative month, and post-transplant lymphoproliferative disorder (PTLD) occurred in the sixth month postoperatively. Malignancies were treated, involving both surgical and medical approaches. The patient developed opportunistic pulmonary and cerebellar aspergillosis. In order to reduce the adverse affects and metabolic and immunological load, the transplanted face was removed and replaced with a free flap. Although the early postoperative period was promising, with the transferred flap surviving totally and all vital signs and general status appearing to be improving, the patient was eventually lost due to complicated infectious and metabolic events. Although this case was unsuccessful, we suggest that the immunological and metabolic load should be reduced as soon as stable medical conditions are established in case of diagnosis of a situation involving a high rate of mortality, such as PTLD and untreatable opportunistic infections. This should include withdrawal of all immunosuppressive drugs and removal of all allotransplanted tissues.

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Face allotransplantation for various types of facial disfigurements: A series of five cases

Özkan

Ubur

et al. 2017

Microsurgery

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Epidemiology, clinical characteristics, and outcome of invasive aspergillosis in renal transplant patients

Abstract: While classical risk factors described for IA in liver recipients are still valid, IA appears later in renal patients and is commonly associated with co-morbid conditions.

Cited by 33 publications

References 34 publications

Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study

Prognosis of Invasive Aspergillosis in Kidney Transplant Recipients: A Case-Control Study

Consideration of difficulties and exit strategies in a case of face allotransplantation resulting in failure

Face allotransplantation for various types of facial disfigurements: A series of five cases

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