Invasive pulmonary aspergillosis after solid organ transplantation: diagnosis and treatment based on 28 years of transplantation experience.

Abstract

Invasive pulmonary aspergillosis (IPA) is a serious and lethal complication among organ transplant recipients. This report described the clinical manifestations and treatment of IPA over a 28-year period. From January 1979 to December 2007, 3215 organ transplant patients (2954 kidney and 261 liver recipients) were enrolled in the study. Nine patients developed IPA (7 kidney and 2 liver recipients), yielding an incidence of 0.003% (9/3215). Five IPA patients (55.6%) were diagnosed by transbronchial lung biopsy or autopsy, and 3 (33.3%) by sputum culture study. One patient was diagnosed through clinical manifestations and observations of IPA characteristics on chest X ray. We used amphotericin B (n = 4; 44.4%), voriconazole (n = 2; 22.2%), or fluconazole (n = 1; 11.1%) as the primary antifungal agents, but 2 patients could not receive antifungal agents due to rapid disease progression and sequential mortality. This study showed a high mortality rate among IPA patients (55.6%; 5/9). Only patients who received early antifungal agent thereby after a prompt diagnosis recovered from IPA. This survival advantage warrants careful monitoring for invasive fungal infections after organ transplantation with immediate administration of antifungal agents or surgical intervention.

• Authors: M K Ju, D J Joo, S J Kim, H K Chang, M S Kim, S I Kim, Y S Kim
• Journal: Transplantation proceedings (Transplant Proc) 2009 Jan-Feb Vol. 41 Issue 1 Pg. 375-8 ISSN: 0041-1345 [Print] United States
• PMID: 19249560 (Publication Type: Journal Article)

Chemical References

• Antifungal Agents
• Immunosuppressive Agents

Topics

• Adult
• Antifungal Agents (therapeutic use)
• Disease Progression
• Drug Therapy, Combination
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Kidney Transplantation (adverse effects)
• Liver Transplantation (adverse effects)
• Male
• Middle Aged
• Postoperative Complications (immunology, microbiology, mortality)
• Pulmonary Aspergillosis (diagnosis, diagnostic imaging, epidemiology, mortality)
• Radiography, Thoracic
• Reoperation (statistics & numerical data)
• Retrospective Studies
• Survival Analysis
• Survivors