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Título:	Multinational case-control study of risk factors for the development of late invasive pulmonary aspergillosis following kidney transplantation
Autor/a:	López Medrano, Francisco; Fernández Ruiz, Mario; Silva, José Tiago; Carver, Peggy L.; Delden, Christian van; Merino, Esperanza; Pérez Sáez, María José; Montero, María Milagro; Coussement, Julien; Abreu Mazzolin, Milene de; Cervera, Carlos; Santos, Lidia; Sabé, Nuria; Scemla, Anne; Cordero, Elisa; Cruzado Vega, Leónidas; Martín Moreno, Paloma Leticia; Len, Óscar; Rudas, Eddison; Ponce de León, Alfredo; Arriola, Mariano; Lauzurica, Ricardo; David, Miruna D.; González Rico, Claudia; Henríquez Palop, Fernando; Fortún, Jesús; Nucci, Marcio; Manuel, Oriol; Paño Pardo, José Ramón; Montejo, Miguel; Vena, Antonio; Sánchez Sobrino, Beatriz; Mazuecos, María A.; Pascual, Julio (Pascual Santos); Horcajada Gallego, Juan Pablo; Lecompte, Thanh; Moreno Camacho, Ma. Asunción; Carratalà, Jordi; Blanes, Marino; Perelló Carrascosa, Manuel; Muñoz, Patricia; Andrés, Amado; Aguado, José María; Spanish Network for Research in Infectious Diseases (REIPI); Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC); Study Group for Infections in Compromised Hosts (ESGICH) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID); Swiss Transplant Cohort Study (STCS)
Notas:	OBJECTIVES: To assess the risk factors for development of late-onset invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT). METHODS: We performed a multinational case-control study that retrospectively recruited 112 KT recipients diagnosed with IPA between 2000 and 2013. Controls were matched (1:1 ratio) by centre and date of transplantation. Immunosuppression-related events (IREs) included the occurrence of non-ventilator-associated pneumonia, tuberculosis, cytomegalovirus disease, and/or de novo malignancy. RESULTS: We identified 61 cases of late (>180 days after transplantation) IPA from 24 participating centres (accounting for 54.5% (61/112) of all cases included in the overall study). Most diagnoses (54.1% (33/61)) were established within the first 36 post-transplant months, although five cases occurred more than 10 years after transplantation. Overall mortality among cases was 47.5% (29/61). Compared with controls, cases were significantly older (p 0.010) and more likely to have pre-transplant chronic obstructive pulmonary disease (p 0.001) and a diagnosis of bloodstream infection (p 0.016) and IRE (p <0.001) within the 6 months prior to the onset of late IPA. After multivariate adjustment, previous occurrence of IRE (OR 19.26; 95% CI 2.07-179.46; p 0.009) was identified as an independent risk factor for late IPA. CONCLUSION: More than half of IPA cases after KT occur beyond the sixth month, with some of them presenting very late. Late IPA entails a poor prognosis. We identified some risk factors that could help the clinician to delimit the subgroup of KT recipients at the highest risk for late IPA.
Materia(s):	-Trasplantament renal -Factors de risc en les malalties -Malalties de l'aparell respiratori -Aspergil·losi -Kidney transplantation -Risk factors in diseases -Respiratory diseases -Aspergillosis
Derechos:	(c) López Medrano, Francisco et al., 2018
Tipo de documento:	Artículo Artículo - Versión aceptada
Editor:	European Society of Clinical Microbiology and Infectious Diseases
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