Invasive aspergillosis in liver transplant recipients in the current era

医学 曲菌病 肝移植 电流(流体) 重症监护医学 内科学 移植 免疫学 电气工程 工程类
作者
Muneyoshi Kimura,Matteo Rinaldi,Sagar Kothari,Maddalena Giannella,Shweta Anjan,Yoichiro Natori,Pakpoom Phoompoung,E.W. Gault,Jonathan Hand,Matilde D’Asaro,Dionysios Neofytos,Nicolas J. Mueller,Andreas E. Kremer,Tereza Rojko,Marija Ribnikar,Fernanda P. Silveira,Joshua B. Kohl,Ángela Cano,Julián Torre‐Cisneros,Rafael San Juan,José María Aguado,Armaghan‐e‐Rehman Mansoor,Ige George,Alessandra Mularoni,Giovanna Russelli,Me‐Linh Luong,Yamama Aljishi,Maram N. AlJishi,Bassem Hamandi,Nazia Selzner,Shahid Husain
出处
期刊:American Journal of Transplantation [Wiley]
卷期号:24 (11): 2092-2107 被引量:1
标识
DOI:10.1016/j.ajt.2024.05.016
摘要

Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multi-center 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in eight cases (13%). 12-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotics usage (adjusted odds ratio [aOR], 4.74; p=0.03) and history of pneumonia (aOR, 48.7; p=0.01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; p=0.01), systemic antibiotics usage (aOR, 5.03; p=0.04), and anti-mold prophylaxis (aOR, 11.9; p=0.02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ration [aHR], 86.9; p<0.001), ICU stay (aHR, 3.67; p=0.02), disseminated IA (aHR, 8.98; p<0.001), and dialysis (aHR, 2.93; p=0.001) were identified as independent risk factors associated with 12-week all-cause mortality; while recent receipt of tacrolimus (aHR, 0.11; p=0.001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted anti-mold prophylactic and appropriate treatment strategies against IA.
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