Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

Neofytos, Dionysios; Chatzis, Olga; Nasioudis, Dimitrios; Janke, Eva; Lecompte, T; Garzoni, Christian; Berger, Christoph; Cussini, A; Boggian, Katja; Khanna, Nina; Manuel, Oriol; Mueller, Nicolas J.; Delden, Christian van

doi:10.1111/tid.12898

Cited by 83 publications

(134 citation statements)

References 52 publications

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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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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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“…Our study was not designed to identify predictive factors for developing IMI in unselected SOT recipients. However, the high incidence of IMI in heart and lung transplant recipients and the small interval from transplantation to the infection in our cohort (median 2.2 months in heart transplant recipients) may prompt administration of antifungal prophylaxis in selected populations or screening of asymptomatic at‐risk patients during outbreaks of invasive aspergillosis . Chronic kidney injury, re‐operation, and bacterial or viral infection were recently identified as risk factors for invasive aspergillosis by the Swiss Transplant Cohort Study .…”

Section: Discussionmentioning

confidence: 90%

“…However, the high incidence of IMI in heart and lung transplant recipients and the small interval from transplantation to the infection in our cohort (median 2.2 months in heart transplant recipients) may prompt administration of antifungal prophylaxis in selected populations or screening of asymptomatic at‐risk patients during outbreaks of invasive aspergillosis . Chronic kidney injury, re‐operation, and bacterial or viral infection were recently identified as risk factors for invasive aspergillosis by the Swiss Transplant Cohort Study . In 10 out of 56 patients (18%), influenza was diagnosed in the 3 months preceding the diagnosis of invasive aspergillosis (10.4% in our series), highlighting the potential link between influenza outbreak and the development of invasive aspergillosis …”

Section: Discussionmentioning

confidence: 93%

“…Frontline antifungal therapy was not standardized over the inclusion period, but all molecules were available and given according to tolerance and underlying fungal sensitivity. Lastly, because typical pulmonary radiographic findings are inconsistent in SOT recipients with invasive aspergillosis, some patients may have been erroneously excluded from the analysis.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections

Farges

Cointault

Murris

et al. 2019

Transplant Infectious Dis

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Objectives To characterize the clinical presentation and outcomes of invasive mold infections (IMI) in solid organ transplant (SOT) recipients. Methods Inclusion of all SOT recipients with IMI diagnosed between 2008 and 2016 at a referral center for SOT. Univariable analyses identified factors associated with death at one year, and logistic regression models retained independent predictors. Results Of the 1739 patients that received a SOT during this period, 68 developed IMI (invasive aspergillosis [IA] in 58). Cumulative incidence of IMI at 1 year ranged from 1.2% to 18.8% (kidney and heart transplantation, respectively). At baseline, compared with other IMI, the need for vasoactive drugs was more frequent in patients with IA. During follow‐up, 35 patients (51%) were admitted to the ICU and required mechanical ventilation (n = 27), vasoactive drugs (n = 31), or renal replacement therapy (n = 31). The need for vasoactive drugs (OR 7.34; P = .003) and a positive direct examination (OR 10.1; P = .004) were independently associated with the risk of death at 1 year in patients with IA (n = 33; 57%) Conclusions Characteristics of IMI at presentation varied according to the underlying transplanted organ and the mold species. Following IA, one‐year mortality may be predicted by the need for hemodynamic support and initial fungal load.

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“…A more contemporary cohort in Switzerland attempted to address this. Data were analyzed from patients transplanted between 2008 and 2014 and showed renal insufficiency, reoperation, and bacterial and viral infections were predictors of invasive aspergillosis; however, only 7 IMIs occurred in liver transplant . Importantly, mortality in the 7 liver transplant patients was 86%.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study evaluating the performance of risk factors for invasive mold infections in liver transplantation

Neyra

Brizendine

2019

Transplant Infectious Dis

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Background Mold infections in liver transplant are associated with high mortality. Guidelines recommend prophylaxis targeted against mold based upon risk factors of fulminant hepatic failure, retransplantation, reoperation, and renal replacement therapy post‐transplant. It is not known if these factors identify risk of mold infection at every center. Methods A retrospective study was conducted of adult liver transplant recipients at a single center from 2010 to 2014. The association between risk factors and invasive mold infection and effect of antifungal prophylaxis were determined. Results Five hundred thirty‐four liver transplant recipients were identified. The overall incidence of invasive mold infection was 0.9% (N = 5). The incidence in patients with (N = 128) and without (N = 406) risk factors was 0.78% and 0.98%, respectively. Antifungal prophylaxis with mold activity was administered to 23/128 (18%) with risk factors, and none developed infection. No mold‐active prophylaxis was given to 105/128 (82%) with risk factors, and incidence of mold infection was 0.95% (N = 1). Number needed to treat was 105. Conclusions Traditional risk factors for mold infection in liver transplant performed poorly. These results underscore the importance of transplant center‐specific data to inform adoption of an antifungal prophylactic strategy. Studies are needed to determine alternative risk factors to facilitate appropriate targeting of antifungals.

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Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study

Abstract: Invasive aspergillosis remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Although overall mortality has decreased in SOTr, it remains high in liver SOTr.

Cited by 83 publications

References 52 publications

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

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

Outcomes of solid organ transplant recipients with invasive aspergillosis and other mold infections

Retrospective study evaluating the performance of risk factors for invasive mold infections in liver transplantation

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