Invasive pulmonary aspergillosis in solid organ transplant patients in the ICU.
(2021) Transplant infectious disease : an official journal of the Transplantation Society — Vol. 24, n° 1, p. e13746 (2021)
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Klein, Joachim 
Rello, Jordi Blot, Stijn
- Abstract
- Solid organ transplantation (SOT) is a well-known risk factor for invasive pulmonary aspergillosis (IPA). We report on the epidemiology and outcome of SOT patients with IPA in an ICU setting. This is a secondary study based on a subset of SOT-patients from a prospective observational multicenter cohort (the AspICU project) including ICU patients with at least one Aspergillus spp. positive culture. Cases were classified as proven, probable, or putative IPA, or as Aspergillus-colonized. Mortality was reported at 12 weeks. The study included 52 SOT-patients (of which 18 lung, 17 liver, 12 kidney and 5 heart transplants. Sixteen patients had proven IPA, 28 were categorized as putative IPA (of which only 5 reached a probable IPA diagnosis according to EORTC/MSGERC criteria) and 8 as Aspergillus-colonization. Among patients with IPA, 20 (45.5%) developed IPA during their ICU stay following transplantation whereas 24 patients (54.5%) had a medical ICU admission. Regarding medical imaging, nearly all IPA cases presented with non-specific findings as only 9 demonstrated robust findings suggestive for invasive fungal disease. Overall, severity of disease was reflected by a high prevalence of underlying conditions and acute organ derangements. Mortality among patients with IPA was 68%. Lung transplantation was associated with better survival (50%). IPA in SOT patients in the ICU develops in the presence of an overall high severity of disease. It rarely presents with suggestive medical imaging thereby hampering diagnosis. IPA in ICU patients with SOT carries a grim prognosis. This article is protected by copyright. All rights reserved.
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Klein, J., Rello, J., Dimopoulos, G., Bulpa, P., Blot, K., Vogelaers, D., & Blot, S. (2021). Invasive pulmonary aspergillosis in solid organ transplant patients in the ICU. Transplant infectious disease : an official journal of the Transplantation Society, 24(1), e13746. https://doi.org/10.1111/tid.13746 (Original work published 2021)