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J Heart Lung Transplant. 2014 Mar;33(3):278-88. doi: 10.1016/j.healun.2013.11.003. Epub 2013 Nov 28.

Invasive aspergillosis among heart transplant recipients: a 24-year perspective.

Author information

1
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid. Electronic address: pmunoz@micro.hggm.es.
2
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid.
3
Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
4
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid; Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid; CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca; Red Española para la Investigación en Patología Infecciosa (RD06/0008/1025), Madrid.

Abstract

BACKGROUND:

Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem.

METHODS:

We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution.

RESULTS:

Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09).

CONCLUSIONS:

In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.

KEYWORDS:

Aspergillus spp; anti-fungal prophylaxis; heart transplantation; invasive aspergillosis

PMID:
24559945
DOI:
10.1016/j.healun.2013.11.003
[Indexed for MEDLINE]

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