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Abstract: The prognostic factors and optimal therapy for invasive
pulmonary aspergillosis (IPA) after kidney transplantation
(KT) remain poorly studied. We included
in this multinational retrospective study 112 recipients
diagnosed with probable (75.0% of cases) or
proven (25.0%) IPA between 2000 and 2013. The
median interval from transplantation to diagnosis
was 230 days. Cough, fever, and expectoration were
the most common symptoms at presentation. Bilateral
pulmonary involvement was observed in 63.6%
of cases. Positivity rates for the galactomannan
assay in serum and bronchoalveolar lavage samples
were 61.3% and 57.1%, respectively. Aspergillus
fumigatus was the most commonly identified species.
Six- and 12-week survival rates were 68.8% and
60.7%, respectively, and 22.1% of survivors experienced
graft loss. Occurrence of IPA within the first
6 months (hazard ratio [HR]: 2.29; p-value = 0.027)
and bilateral involvement at diagnosis (HR: 3.00; pvalue
= 0.017) were independent predictors for 6-
week all-cause mortality, whereas the initial use of a
voriconazole-based regimen showed a protective
effect (HR: 0.34; p-value = 0.007). The administration
of antifungal combination therapy had no apparent
impact on outcome. In conclusion, IPA entails a dismal
prognosis among KT recipients. Maintaining a
low clinical suspicion threshold is key to achieve a
prompt diagnosis and to initiate voriconazole
Fuente: Am J Transplant 2016; 16: 3220?3234
Editorial: Wiley Periodicals Inc.
Año de publicación: 2016
Nº de páginas: 15
Tipo de publicación: Artículo de Revista
DOI: doi: 10.1111/ajt.13837
LÓPEZ MEDRANO, F.
FERNÁNDEZ RUIZ, M.
SILVA, J. T.
CARVER, P. L.
DELDEN, C. VAN
PÉREZ SAEZ, M. J.
ABREU MAZZOLIN, M. DE
CRUZADO VEGA, L.
MORENO, P. L.
MARIA DEL CARMEN FARIÑAS ALVAREZ