Invasive Aspergillosis in solid-organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Invasive Aspergillosis in solid-organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
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DOI：
10.1111/ctr.13544
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发表时间：
2019-09-01
影响因子：
2.1
通讯作者：
Camargo, Jose F.
中科院分区：
文献类型：
--
作者：
Husain, Shahid;Camargo, Jose F.
这些更新的AST-IDCOP指南提供了器官移植后曲霉的流行病学、诊断和管理信息。曲霉是实体器官移植（SOT）受者中最常见的侵袭性霉菌感染，也是肺移植受者中最常见的侵袭性真菌感染。从移植到诊断侵袭性曲霉病（IA）的时间是可变的，但大多数病例出现在移植后的第一年，肝和心脏移植受者发病时间最短。SOT中IA的总12周死亡率超过20%；中枢神经系统受累或播散性疾病患者预后较差。支气管肺泡灌洗半乳甘露聚糖是诊断肺和非肺移植受者IA的首选方法，并结合其他诊断方式（如胸部CT扫描、培养）。伏立康唑仍然是治疗IA的首选药物，异戊康唑和两性霉素B脂质制剂被认为是替代药物。联合抗真菌药物在IA初级治疗中的作用仍然存在争议。肺移植受者推荐普遍预防或先发制人的治疗，而肝和心脏移植受者则倾向于有针对性的预防。在这些指南中，我们还讨论了新的抗真菌药物和诊断试验，抗真菌药敏试验和特殊患者群体。
These updated AST-IDCOP guidelines provide information on epidemiology, diagnosis, and management of Aspergillus after organ transplantation. Aspergillus is the most common invasive mold infection in solid-organ transplant (SOT) recipients, and it is the most common invasive fungal infection among lung transplant recipients. Time from transplant to diagnosis of invasive aspergillosis (IA) is variable, but most cases present within the first year post-transplant, with shortest time to onset among liver and heart transplant recipients. The overall 12-week mortality of IA in SOT exceeds 20%; prognosis is worse among those with central nervous system involvement or disseminated disease. Bronchoalveolar lavage galactomannan is preferred for the diagnosis of IA in lung and non-lung transplant recipients, in combination with other diagnostic modalities (eg, chest CT scan, culture). Voriconazole remains the drug of choice to treat IA, with isavuconazole and lipid formulations of amphotericin B regarded as alternative agents. The role of combination antifungals for primary therapy of IA remains controversial. Either universal prophylaxis or preemptive therapy is recommended in lung transplant recipients, whereas targeted prophylaxis is favored in liver and heart transplant recipients. In these guidelines, we also discuss newer antifungals and diagnostic tests, antifungal susceptibility testing, and special patient populations.