Risk factors for invasive aspergillosis in solid-organ transplant recipients: A case-control study
Risk factors for invasive aspergillosis in solid-organ transplant recipients: A case-control study
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DOI：
10.1086/430602
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发表时间：
2005-07-01
影响因子：
11.8
通讯作者：
Pahissa, A
中科院分区：
文献类型：
--
作者：
Gavalda, J;Len, O;Pahissa, A
背景为了促进实体器官移植受者侵袭性曲霉菌病预防策略的设计，本研究调查早发性和迟发性曲霉菌病的发生是否与不同的危险因素有关，从而区分这种严重并发症的2种危险人群。我们进行了一项回顾性病例对照研究，纳入了156例确诊或可能为侵袭性曲霉菌病的患者，这些患者是从西班牙11个中心的移植项目开始以来招募的。在所有患者中，57%有早发性IA（即，发生在移植后的前3个月）。该组的风险因素分析确定了与之显著相关的风险因素：更复杂的术后时期、反复细菌感染或巨细胞病毒疾病、肾衰竭或需要透析。在迟发性感染患者中（即，发生在移植后13个月），占43%的病例，处于危险中的患者年龄较大，由于慢性移植排斥反应或移植物功能障碍而处于过度免疫抑制状态，并有移植后肾功能衰竭。早发型病例和迟发型移植后侵袭性曲霉病患者的危险因素是不一样的，这一事实可能对这种感染的预防方法产生影响。
Background. To facilitate the design of strategies for prevention of invasive aspergillosis in solid-organ transplant recipients, this study investigates whether the development of early-onset and late-onset aspergillosis are related to different risk factors, thereby distinguishing 2 risk populations for this serious complication.Methods. A retrospective case-control study was performed, including 156 cases of proven or probable invasive aspergillosis in patients recruited from 11 Spanish centers since the start of the centers' transplantation programs.Results. Among all patients, 57% had early-onset IA (i.e., occurred during the first 3 months after transplantation). Risk factor analysis in this group identified as significantly associated risk factors a more complicated postoperative period, repeated bacterial infections or cytomegalovirus disease, and renal failure or the need for dialysis. Among patients with late-onset infections (i.e., occurred 13 months after transplantation), who comprised 43% of cases, the patients at risk were older, were in an overimmunosuppressed state because of chronic transplant rejection or allograft dysfunction, and had posttransplantation renal failure.Conclusions. Risk factors in patients with early-onset cases and patients with late-onset cases of posttransplantation invasive aspergillosis are not the same, a fact that could have implications for the preventive approaches used for this infection.