Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)
Background The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined. Patients and Methods The Diaspersot cohort analyses the impact of IA i...
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| Veröffentlicht in: | Mycoses 2021-11, Vol.64 (11), p.1334-1345 |
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| creator | Gioia, Francesca Filigheddu, Eta Corbella, Laura Fernández‐Ruiz, Mario López‐Medrano, Francisco Pérez‐Ayala, Ana Aguado, Jose María Fariñas, Maria Carmen Arnaiz, Francisco Calvo, Jorge Cifrian, Jose Maria Gonzalez‐Rico, Claudia Vidal, Elisa Torre‐Cisneros, Julian Ras, Maria Mar Pérez, Sandra Sabe, Nuria López‐Soria, Leyre Monica Rodríguez‐Alvarez, Regino Jose Montejo, José Miguel Valerio, Maricela Machado, Marina Muñoz, Patricia Linares, Laura Bodro, Marta Moreno, Asuncion Fernández‐Cruz, Ana Cantón, Rafael Moreno, Santiago Martin‐Davila, Pilar Fortún, Jesús |
| description | Background
The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined.
Patients and Methods
The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included.
Results
We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree‐in‐bud sign or ground‐glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p |
| doi_str_mv | 10.1111/myc.13298 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2521496351</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2521496351</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3538-4bf93bb2e0633ad91bf88902d8fa252c1ca89b72c3f36572973484c869f443873</originalsourceid><addsrcrecordid>eNp1kcFu1DAQhi0EokvhwAsgS1zaQ1o74yQ2t2qBtlIRB-DAKXIcZ9eVYwdPUrRPwuvi3S0ckJjLzOHTN_r1E_Kaswue53LcmQsOpZJPyIoLUAWrWPOUrJgCKBrBmhPyAvGeMd6osn5OTgAUCMGqFfl1Gx40ugdLNU42bZz3ER1SFyhG73oa00YHOicdcPI6zHp2Mbyj753ehIizM9Rstfc2bCxSHXrau2GwyQZjD5a4zCaOdn9q-mXSweGWhoNFe2riNqaZnmXd_j3GmeK89Lvzl-TZoD3aV4_7lHz7-OHr-qa4-3x9u766KwxUIAvRDQq6rrSsBtC94t0gpWJlLwddVqXhRkvVNaWBAeqqKVUDQgojazUIAbKBU3J29E4p_lgszu3o0Fifo9q4YJslXKgaKp7Rt_-g93FJOcWekgCZlGWmzo-USREx2aGdkht12rWctfu22txWe2grs28ejUs32v4v-aeeDFwegZ_O293_Te2n7-uj8jc7wqBQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2583352182</pqid></control><display><type>article</type><title>Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)</title><source>Access via Wiley Online Library</source><creator>Gioia, Francesca ; Filigheddu, Eta ; Corbella, Laura ; Fernández‐Ruiz, Mario ; López‐Medrano, Francisco ; Pérez‐Ayala, Ana ; Aguado, Jose María ; Fariñas, Maria Carmen ; Arnaiz, Francisco ; Calvo, Jorge ; Cifrian, Jose Maria ; Gonzalez‐Rico, Claudia ; Vidal, Elisa ; Torre‐Cisneros, Julian ; Ras, Maria Mar ; Pérez, Sandra ; Sabe, Nuria ; López‐Soria, Leyre Monica ; Rodríguez‐Alvarez, Regino Jose ; Montejo, José Miguel ; Valerio, Maricela ; Machado, Marina ; Muñoz, Patricia ; Linares, Laura ; Bodro, Marta ; Moreno, Asuncion ; Fernández‐Cruz, Ana ; Cantón, Rafael ; Moreno, Santiago ; Martin‐Davila, Pilar ; Fortún, Jesús</creator><creatorcontrib>Gioia, Francesca ; Filigheddu, Eta ; Corbella, Laura ; Fernández‐Ruiz, Mario ; López‐Medrano, Francisco ; Pérez‐Ayala, Ana ; Aguado, Jose María ; Fariñas, Maria Carmen ; Arnaiz, Francisco ; Calvo, Jorge ; Cifrian, Jose Maria ; Gonzalez‐Rico, Claudia ; Vidal, Elisa ; Torre‐Cisneros, Julian ; Ras, Maria Mar ; Pérez, Sandra ; Sabe, Nuria ; López‐Soria, Leyre Monica ; Rodríguez‐Alvarez, Regino Jose ; Montejo, José Miguel ; Valerio, Maricela ; Machado, Marina ; Muñoz, Patricia ; Linares, Laura ; Bodro, Marta ; Moreno, Asuncion ; Fernández‐Cruz, Ana ; Cantón, Rafael ; Moreno, Santiago ; Martin‐Davila, Pilar ; Fortún, Jesús</creatorcontrib><description>Background
The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined.
Patients and Methods
The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included.
Results
We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree‐in‐bud sign or ground‐glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p < 0.001) in lung transplant recipients (14.8%) than in all other transplants [globally: 48.6%; kidney 52.0%, liver 58.3%, heart 31.2%, and combined 42.9%]. Fifty‐four percent of episodes occurred despite the receipt of antifungal prophylaxis, and in 10%, IA occurred during prophylaxis (breakthrough infection), with both nebulised amphotericin (in lung transplant recipients) and candins (in the rest).
Conclusions
Invasive aspergillosis diagnostic criteria, applied to SOT patients, may differ from those established for haematological patients. IA in lung transplants has a higher incidence, but is associated with a better prognosis than other transplants. Combination therapy is frequently used for IA in SOT. Prophylactic measures require optimisation of its use within this population.</description><identifier>ISSN: 0933-7407</identifier><identifier>EISSN: 1439-0507</identifier><identifier>DOI: 10.1111/myc.13298</identifier><identifier>PMID: 33934405</identifier><language>eng</language><publisher>Germany: Wiley Subscription Services, Inc</publisher><subject>Aspergillosis ; diagnostic criteria ; Disease prevention ; epidemiology ; Heart transplantation ; invasive aspergillosis ; Kidney transplantation ; Liver transplantation ; Lung transplantation ; Lung transplants ; Optical density ; Prognosis ; Prophylaxis ; solid organ transplant</subject><ispartof>Mycoses, 2021-11, Vol.64 (11), p.1334-1345</ispartof><rights>2021 Wiley-VCH GmbH</rights><rights>This article is protected by copyright. All rights reserved.</rights><rights>2021 Blackwell Verlag GmbH</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-4bf93bb2e0633ad91bf88902d8fa252c1ca89b72c3f36572973484c869f443873</citedby><cites>FETCH-LOGICAL-c3538-4bf93bb2e0633ad91bf88902d8fa252c1ca89b72c3f36572973484c869f443873</cites><orcidid>0000-0003-1189-1120 ; 0000-0002-7988-6945 ; 0000-0003-1529-6302 ; 0000-0002-0315-8001 ; 0000-0002-9520-8255 ; 0000-0002-6959-5263 ; 0000-0002-7469-897X ; 0000-0002-3102-1352 ; 0000-0002-8370-2248 ; 0000-0002-0520-8279 ; 0000-0001-5706-5583 ; 0000-0003-1600-0681 ; 0000-0003-1675-3173 ; 0000-0001-6394-2861 ; 0000-0001-7432-0830 ; 0000-0001-6382-0039 ; 0000-0001-5333-7529 ; 0000-0002-2843-1094 ; 0000-0003-1697-4347</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fmyc.13298$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fmyc.13298$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33934405$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gioia, Francesca</creatorcontrib><creatorcontrib>Filigheddu, Eta</creatorcontrib><creatorcontrib>Corbella, Laura</creatorcontrib><creatorcontrib>Fernández‐Ruiz, Mario</creatorcontrib><creatorcontrib>López‐Medrano, Francisco</creatorcontrib><creatorcontrib>Pérez‐Ayala, Ana</creatorcontrib><creatorcontrib>Aguado, Jose María</creatorcontrib><creatorcontrib>Fariñas, Maria Carmen</creatorcontrib><creatorcontrib>Arnaiz, Francisco</creatorcontrib><creatorcontrib>Calvo, Jorge</creatorcontrib><creatorcontrib>Cifrian, Jose Maria</creatorcontrib><creatorcontrib>Gonzalez‐Rico, Claudia</creatorcontrib><creatorcontrib>Vidal, Elisa</creatorcontrib><creatorcontrib>Torre‐Cisneros, Julian</creatorcontrib><creatorcontrib>Ras, Maria Mar</creatorcontrib><creatorcontrib>Pérez, Sandra</creatorcontrib><creatorcontrib>Sabe, Nuria</creatorcontrib><creatorcontrib>López‐Soria, Leyre Monica</creatorcontrib><creatorcontrib>Rodríguez‐Alvarez, Regino Jose</creatorcontrib><creatorcontrib>Montejo, José Miguel</creatorcontrib><creatorcontrib>Valerio, Maricela</creatorcontrib><creatorcontrib>Machado, Marina</creatorcontrib><creatorcontrib>Muñoz, Patricia</creatorcontrib><creatorcontrib>Linares, Laura</creatorcontrib><creatorcontrib>Bodro, Marta</creatorcontrib><creatorcontrib>Moreno, Asuncion</creatorcontrib><creatorcontrib>Fernández‐Cruz, Ana</creatorcontrib><creatorcontrib>Cantón, Rafael</creatorcontrib><creatorcontrib>Moreno, Santiago</creatorcontrib><creatorcontrib>Martin‐Davila, Pilar</creatorcontrib><creatorcontrib>Fortún, Jesús</creatorcontrib><title>Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)</title><title>Mycoses</title><addtitle>Mycoses</addtitle><description>Background
The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined.
Patients and Methods
The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included.
Results
We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree‐in‐bud sign or ground‐glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p < 0.001) in lung transplant recipients (14.8%) than in all other transplants [globally: 48.6%; kidney 52.0%, liver 58.3%, heart 31.2%, and combined 42.9%]. Fifty‐four percent of episodes occurred despite the receipt of antifungal prophylaxis, and in 10%, IA occurred during prophylaxis (breakthrough infection), with both nebulised amphotericin (in lung transplant recipients) and candins (in the rest).
Conclusions
Invasive aspergillosis diagnostic criteria, applied to SOT patients, may differ from those established for haematological patients. IA in lung transplants has a higher incidence, but is associated with a better prognosis than other transplants. Combination therapy is frequently used for IA in SOT. Prophylactic measures require optimisation of its use within this population.</description><subject>Aspergillosis</subject><subject>diagnostic criteria</subject><subject>Disease prevention</subject><subject>epidemiology</subject><subject>Heart transplantation</subject><subject>invasive aspergillosis</subject><subject>Kidney transplantation</subject><subject>Liver transplantation</subject><subject>Lung transplantation</subject><subject>Lung transplants</subject><subject>Optical density</subject><subject>Prognosis</subject><subject>Prophylaxis</subject><subject>solid organ transplant</subject><issn>0933-7407</issn><issn>1439-0507</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kcFu1DAQhi0EokvhwAsgS1zaQ1o74yQ2t2qBtlIRB-DAKXIcZ9eVYwdPUrRPwuvi3S0ckJjLzOHTN_r1E_Kaswue53LcmQsOpZJPyIoLUAWrWPOUrJgCKBrBmhPyAvGeMd6osn5OTgAUCMGqFfl1Gx40ugdLNU42bZz3ER1SFyhG73oa00YHOicdcPI6zHp2Mbyj753ehIizM9Rstfc2bCxSHXrau2GwyQZjD5a4zCaOdn9q-mXSweGWhoNFe2riNqaZnmXd_j3GmeK89Lvzl-TZoD3aV4_7lHz7-OHr-qa4-3x9u766KwxUIAvRDQq6rrSsBtC94t0gpWJlLwddVqXhRkvVNaWBAeqqKVUDQgojazUIAbKBU3J29E4p_lgszu3o0Fifo9q4YJslXKgaKp7Rt_-g93FJOcWekgCZlGWmzo-USREx2aGdkht12rWctfu22txWe2grs28ejUs32v4v-aeeDFwegZ_O293_Te2n7-uj8jc7wqBQ</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Gioia, Francesca</creator><creator>Filigheddu, Eta</creator><creator>Corbella, Laura</creator><creator>Fernández‐Ruiz, Mario</creator><creator>López‐Medrano, Francisco</creator><creator>Pérez‐Ayala, Ana</creator><creator>Aguado, Jose María</creator><creator>Fariñas, Maria Carmen</creator><creator>Arnaiz, Francisco</creator><creator>Calvo, Jorge</creator><creator>Cifrian, Jose Maria</creator><creator>Gonzalez‐Rico, Claudia</creator><creator>Vidal, Elisa</creator><creator>Torre‐Cisneros, Julian</creator><creator>Ras, Maria Mar</creator><creator>Pérez, Sandra</creator><creator>Sabe, Nuria</creator><creator>López‐Soria, Leyre Monica</creator><creator>Rodríguez‐Alvarez, Regino Jose</creator><creator>Montejo, José Miguel</creator><creator>Valerio, Maricela</creator><creator>Machado, Marina</creator><creator>Muñoz, Patricia</creator><creator>Linares, Laura</creator><creator>Bodro, Marta</creator><creator>Moreno, Asuncion</creator><creator>Fernández‐Cruz, Ana</creator><creator>Cantón, Rafael</creator><creator>Moreno, Santiago</creator><creator>Martin‐Davila, Pilar</creator><creator>Fortún, Jesús</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1189-1120</orcidid><orcidid>https://orcid.org/0000-0002-7988-6945</orcidid><orcidid>https://orcid.org/0000-0003-1529-6302</orcidid><orcidid>https://orcid.org/0000-0002-0315-8001</orcidid><orcidid>https://orcid.org/0000-0002-9520-8255</orcidid><orcidid>https://orcid.org/0000-0002-6959-5263</orcidid><orcidid>https://orcid.org/0000-0002-7469-897X</orcidid><orcidid>https://orcid.org/0000-0002-3102-1352</orcidid><orcidid>https://orcid.org/0000-0002-8370-2248</orcidid><orcidid>https://orcid.org/0000-0002-0520-8279</orcidid><orcidid>https://orcid.org/0000-0001-5706-5583</orcidid><orcidid>https://orcid.org/0000-0003-1600-0681</orcidid><orcidid>https://orcid.org/0000-0003-1675-3173</orcidid><orcidid>https://orcid.org/0000-0001-6394-2861</orcidid><orcidid>https://orcid.org/0000-0001-7432-0830</orcidid><orcidid>https://orcid.org/0000-0001-6382-0039</orcidid><orcidid>https://orcid.org/0000-0001-5333-7529</orcidid><orcidid>https://orcid.org/0000-0002-2843-1094</orcidid><orcidid>https://orcid.org/0000-0003-1697-4347</orcidid></search><sort><creationdate>202111</creationdate><title>Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)</title><author>Gioia, Francesca ; Filigheddu, Eta ; Corbella, Laura ; Fernández‐Ruiz, Mario ; López‐Medrano, Francisco ; Pérez‐Ayala, Ana ; Aguado, Jose María ; Fariñas, Maria Carmen ; Arnaiz, Francisco ; Calvo, Jorge ; Cifrian, Jose Maria ; Gonzalez‐Rico, Claudia ; Vidal, Elisa ; Torre‐Cisneros, Julian ; Ras, Maria Mar ; Pérez, Sandra ; Sabe, Nuria ; López‐Soria, Leyre Monica ; Rodríguez‐Alvarez, Regino Jose ; Montejo, José Miguel ; Valerio, Maricela ; Machado, Marina ; Muñoz, Patricia ; Linares, Laura ; Bodro, Marta ; Moreno, Asuncion ; Fernández‐Cruz, Ana ; Cantón, Rafael ; Moreno, Santiago ; Martin‐Davila, Pilar ; Fortún, Jesús</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3538-4bf93bb2e0633ad91bf88902d8fa252c1ca89b72c3f36572973484c869f443873</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aspergillosis</topic><topic>diagnostic criteria</topic><topic>Disease prevention</topic><topic>epidemiology</topic><topic>Heart transplantation</topic><topic>invasive aspergillosis</topic><topic>Kidney transplantation</topic><topic>Liver transplantation</topic><topic>Lung transplantation</topic><topic>Lung transplants</topic><topic>Optical density</topic><topic>Prognosis</topic><topic>Prophylaxis</topic><topic>solid organ transplant</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gioia, Francesca</creatorcontrib><creatorcontrib>Filigheddu, Eta</creatorcontrib><creatorcontrib>Corbella, Laura</creatorcontrib><creatorcontrib>Fernández‐Ruiz, Mario</creatorcontrib><creatorcontrib>López‐Medrano, Francisco</creatorcontrib><creatorcontrib>Pérez‐Ayala, Ana</creatorcontrib><creatorcontrib>Aguado, Jose María</creatorcontrib><creatorcontrib>Fariñas, Maria Carmen</creatorcontrib><creatorcontrib>Arnaiz, Francisco</creatorcontrib><creatorcontrib>Calvo, Jorge</creatorcontrib><creatorcontrib>Cifrian, Jose Maria</creatorcontrib><creatorcontrib>Gonzalez‐Rico, Claudia</creatorcontrib><creatorcontrib>Vidal, Elisa</creatorcontrib><creatorcontrib>Torre‐Cisneros, Julian</creatorcontrib><creatorcontrib>Ras, Maria Mar</creatorcontrib><creatorcontrib>Pérez, Sandra</creatorcontrib><creatorcontrib>Sabe, Nuria</creatorcontrib><creatorcontrib>López‐Soria, Leyre Monica</creatorcontrib><creatorcontrib>Rodríguez‐Alvarez, Regino Jose</creatorcontrib><creatorcontrib>Montejo, José Miguel</creatorcontrib><creatorcontrib>Valerio, Maricela</creatorcontrib><creatorcontrib>Machado, Marina</creatorcontrib><creatorcontrib>Muñoz, Patricia</creatorcontrib><creatorcontrib>Linares, Laura</creatorcontrib><creatorcontrib>Bodro, Marta</creatorcontrib><creatorcontrib>Moreno, Asuncion</creatorcontrib><creatorcontrib>Fernández‐Cruz, Ana</creatorcontrib><creatorcontrib>Cantón, Rafael</creatorcontrib><creatorcontrib>Moreno, Santiago</creatorcontrib><creatorcontrib>Martin‐Davila, Pilar</creatorcontrib><creatorcontrib>Fortún, Jesús</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Mycoses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gioia, Francesca</au><au>Filigheddu, Eta</au><au>Corbella, Laura</au><au>Fernández‐Ruiz, Mario</au><au>López‐Medrano, Francisco</au><au>Pérez‐Ayala, Ana</au><au>Aguado, Jose María</au><au>Fariñas, Maria Carmen</au><au>Arnaiz, Francisco</au><au>Calvo, Jorge</au><au>Cifrian, Jose Maria</au><au>Gonzalez‐Rico, Claudia</au><au>Vidal, Elisa</au><au>Torre‐Cisneros, Julian</au><au>Ras, Maria Mar</au><au>Pérez, Sandra</au><au>Sabe, Nuria</au><au>López‐Soria, Leyre Monica</au><au>Rodríguez‐Alvarez, Regino Jose</au><au>Montejo, José Miguel</au><au>Valerio, Maricela</au><au>Machado, Marina</au><au>Muñoz, Patricia</au><au>Linares, Laura</au><au>Bodro, Marta</au><au>Moreno, Asuncion</au><au>Fernández‐Cruz, Ana</au><au>Cantón, Rafael</au><au>Moreno, Santiago</au><au>Martin‐Davila, Pilar</au><au>Fortún, Jesús</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study)</atitle><jtitle>Mycoses</jtitle><addtitle>Mycoses</addtitle><date>2021-11</date><risdate>2021</risdate><volume>64</volume><issue>11</issue><spage>1334</spage><epage>1345</epage><pages>1334-1345</pages><issn>0933-7407</issn><eissn>1439-0507</eissn><abstract>Background
The diagnosis of invasive aspergillosis (IA) can be problematic in solid organ transplantation (SOT). The prognosis greatly varies according to the type of transplant, and the impact of prophylaxis is not well defined.
Patients and Methods
The Diaspersot cohort analyses the impact of IA in SOT in Spain during the last 10 years. Proven and probable/putative IA was included.
Results
We analysed 126 cases of IA. The incidences of IA were as follows: 6.5%, 2.9%, 1.8% and 0.6% for lung, heart, liver and kidney transplantation, respectively. EORTC/MSG criteria confirmed only 49.7% of episodes. Tree‐in‐bud sign or ground‐glass infiltrates were present in 56.3% of patients, while serum galactomannan (optical density index >0.5) was positive in 50.6%. A total of 41.3% received combined antifungal therapy. Overall mortality at 3 months was significantly lower (p < 0.001) in lung transplant recipients (14.8%) than in all other transplants [globally: 48.6%; kidney 52.0%, liver 58.3%, heart 31.2%, and combined 42.9%]. Fifty‐four percent of episodes occurred despite the receipt of antifungal prophylaxis, and in 10%, IA occurred during prophylaxis (breakthrough infection), with both nebulised amphotericin (in lung transplant recipients) and candins (in the rest).
Conclusions
Invasive aspergillosis diagnostic criteria, applied to SOT patients, may differ from those established for haematological patients. IA in lung transplants has a higher incidence, but is associated with a better prognosis than other transplants. Combination therapy is frequently used for IA in SOT. Prophylactic measures require optimisation of its use within this population.</abstract><cop>Germany</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33934405</pmid><doi>10.1111/myc.13298</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0003-1189-1120</orcidid><orcidid>https://orcid.org/0000-0002-7988-6945</orcidid><orcidid>https://orcid.org/0000-0003-1529-6302</orcidid><orcidid>https://orcid.org/0000-0002-0315-8001</orcidid><orcidid>https://orcid.org/0000-0002-9520-8255</orcidid><orcidid>https://orcid.org/0000-0002-6959-5263</orcidid><orcidid>https://orcid.org/0000-0002-7469-897X</orcidid><orcidid>https://orcid.org/0000-0002-3102-1352</orcidid><orcidid>https://orcid.org/0000-0002-8370-2248</orcidid><orcidid>https://orcid.org/0000-0002-0520-8279</orcidid><orcidid>https://orcid.org/0000-0001-5706-5583</orcidid><orcidid>https://orcid.org/0000-0003-1600-0681</orcidid><orcidid>https://orcid.org/0000-0003-1675-3173</orcidid><orcidid>https://orcid.org/0000-0001-6394-2861</orcidid><orcidid>https://orcid.org/0000-0001-7432-0830</orcidid><orcidid>https://orcid.org/0000-0001-6382-0039</orcidid><orcidid>https://orcid.org/0000-0001-5333-7529</orcidid><orcidid>https://orcid.org/0000-0002-2843-1094</orcidid><orcidid>https://orcid.org/0000-0003-1697-4347</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0933-7407 |
| ispartof | Mycoses, 2021-11, Vol.64 (11), p.1334-1345 |
| issn | 0933-7407 1439-0507 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2521496351 |
| source | Access via Wiley Online Library |
| subjects | Aspergillosis diagnostic criteria Disease prevention epidemiology Heart transplantation invasive aspergillosis Kidney transplantation Liver transplantation Lung transplantation Lung transplants Optical density Prognosis Prophylaxis solid organ transplant |
| title | Invasive aspergillosis in solid organ transplantation: Diagnostic challenges and differences in outcome in a Spanish national cohort (Diaspersot study) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T00%3A10%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Invasive%20aspergillosis%20in%20solid%20organ%20transplantation:%20Diagnostic%20challenges%20and%20differences%20in%20outcome%20in%20a%20Spanish%20national%20cohort%20(Diaspersot%20study)&rft.jtitle=Mycoses&rft.au=Gioia,%20Francesca&rft.date=2021-11&rft.volume=64&rft.issue=11&rft.spage=1334&rft.epage=1345&rft.pages=1334-1345&rft.issn=0933-7407&rft.eissn=1439-0507&rft_id=info:doi/10.1111/myc.13298&rft_dat=%3Cproquest_cross%3E2521496351%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2583352182&rft_id=info:pmid/33934405&rfr_iscdi=true |