Risk factors for the development of invasive aspergillosis after kidney transplantation: Systematic review and meta‐analysis

To investigate risk factors for invasive aspergillosis (IA) after kidney transplantation (KT), we conducted a systematic search in PubMed and EMBASE to identify studies published until June 2020. We included case‐control or cohort design studies comprising KT recipients with a diagnosis of IA, defined according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria, and assessed risk factors for the development of IA. Random‐effect models meta‐analysis served to pool data. We identified eleven case‐control studies (319 IA cases and 835 controls). There was an increased risk of IA among recipients with underlying chronic lung diseases (odds ratio [OR] = 7.26; 95% confidence interval [CI] = 1.05‐50.06) and among those with diabetic nephropathy (OR = 1.65; 95% CI = 1.10‐2.48). Requiring posttransplant hemodialysis (OR = 3.69; 95% CI = 2.13‐6.37) or surgical reintervention (OR = 6.28; 95% CI = 1.67‐23.66) were also associated with an increased risk. Moreover, a positive link was identified between IA and posttransplant bacterial infection (OR = 7.51; 95% CI = 4.37‐12.91), respiratory tract viral infection (OR = 7.75; 95% CI = 1.60‐37.57), cytomegalovirus infection or disease (OR = 2.67; 95% CI = 1.12‐6.32), and acute graft rejection (OR = 3.01; 95% CI = 1.78‐5.09). In contrast, receiving a kidney from a living donor was associated with a reduced risk (OR = 0.65; 95% CI = 0.46‐0.93). KT recipients that accumulate several of these conditions should be closely monitored and a low threshold of suspicion for IA should be maintained. Future studies should explore the benefit of mold‐active prophylaxis to this subgroup of KT recipients at highest risk. The authors identify several risk factors associated with the development of invasive aspergillosis in kidney transplant recipients.