[Early diagnosis and treatment of invasive pulmonary aspergillosis following kidney transplantation].

Abstract

OBJECTIVE:

To investigate the early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) infection following kidney transplantation.

METHODS:

A retrospective analysis was carried out in 16 IPA patients after kidney transplantation from January 2002 to March 2008. There were 7 males and 9 females with a mean age of 42.9 years old. The prevalence of IPA was 2.21%. The induction therapy was given to 12 patients, 5 with CD25 monoclonal antibody and 7 with anti-thymocyte globulin (ATG). All 6 with acute pre-infection rejection were given the methylprednisolone sodium or ATG therapy.

RESULTS:

The intervals between transplantation and diagnosis were largely within 3 months. Persistent or intermittent fever was the main post-operative symptom. High resolution computed tomography (HRCT) of thorax and bronchoalveolar lavage fluid (BALF) for culture were the main evidence of clinical diagnosis. Amphotericin B (0.15 - 0.5 mg * kg(-1) * d(-1)) might be the major treatment for IPA because of its satisfactory initial therapeutic effect. The mortality rate was 7/16 (43.75%). Of the 9 surviving patients, 8 were treated before the test results were available.

CONCLUSIONS:

The clinical symptoms of IPA following kidney transplantation are atypical in the early stage so that it is easy to misdiagnoses and a high mortality rate ensues. Major risk factors for IPA include administration of ATG, CD25 monoclonal antibody and steroid boluses for prevention or treatment of allograft rejection; prolonged broad-spectrum antibiotic use after transplantation and environmental factors. Early diagnosis and empirical use of antifungal agents while waiting for a definitive diagnosis are imperative in achieving a favorable outcome.

• Authors: Wei Wang, Xiao-bei Li, Yi Ding, Hang Yin, Hang Liu, Xiao-peng Hu, Yong Wang, Xiao-dong Zhang
• Journal: Zhonghua yi xue za zhi (Zhonghua Yi Xue Za Zhi) Vol. 90 Issue 2 Pg. 110-2 (Jan 12 2010) ISSN: 0376-2491 [Print] China
• PMID: 20356494 (Publication Type: English Abstract, Journal Article)

Chemical References

• Antifungal Agents

Topics

• Adult
• Antifungal Agents (therapeutic use)
• Early Diagnosis
• Female
• Humans
• Invasive Pulmonary Aspergillosis (diagnosis, drug therapy, etiology)
• Kidney Transplantation (adverse effects)
• Male
• Middle Aged
• Retrospective Studies