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Invasive pulmonary aspergillosis after solid organ transplantation: diagnosis and treatment based on 28 years of transplantation experience

Authors
 M.K. Ju  ;  D.J. Joo  ;  S.J. Kim  ;  H.K. Chang  ;  M.S. Kim  ;  S.I. Kim  ;  Y.S. Kim 
Citation
 TRANSPLANTATION PROCEEDINGS, Vol.41(1) : 375-378, 2009 
Journal Title
 TRANSPLANTATION PROCEEDINGS 
ISSN
 0041-1345 
Issue Date
2009
MeSH
Adult ; Antifungal Agents/therapeutic use* ; Disease Progression ; Drug Therapy, Combination ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Kidney Transplantation/adverse effects* ; Liver Transplantation/adverse effects* ; Male ; Middle Aged ; Postoperative Complications/immunology ; Postoperative Complications/microbiology* ; Postoperative Complications/mortality ; Pulmonary Aspergillosis/diagnosis* ; Pulmonary Aspergillosis/diagnostic imaging ; Pulmonary Aspergillosis/epidemiology* ; Pulmonary Aspergillosis/mortality ; Radiography, Thoracic ; Reoperation/statistics & numerical data ; Retrospective Studies ; Survival Analysis ; Survivors
Abstract
Invasive pulmonary aspergillosis (IPA) is a serious and lethal complication among organ transplant recipients. This report described the clinical manifestations and treatment of IPA over a 28-year period. From January 1979 to December 2007, 3215 organ transplant patients (2954 kidney and 261 liver recipients) were enrolled in the study. Nine patients developed IPA (7 kidney and 2 liver recipients), yielding an incidence of 0.003% (9/3215). Five IPA patients (55.6%) were diagnosed by transbronchial lung biopsy or autopsy, and 3 (33.3%) by sputum culture study. One patient was diagnosed through clinical manifestations and observations of IPA characteristics on chest X ray. We used amphotericin B (n = 4; 44.4%), voriconazole (n = 2; 22.2%), or fluconazole (n = 1; 11.1%) as the primary antifungal agents, but 2 patients could not receive antifungal agents due to rapid disease progression and sequential mortality. This study showed a high mortality rate among IPA patients (55.6%; 5/9). Only patients who received early antifungal agent thereby after a prompt diagnosis recovered from IPA. This survival advantage warrants careful monitoring for invasive fungal infections after organ transplantation with immediate administration of antifungal agents or surgical intervention.
Full Text
http://www.sciencedirect.com/science/article/pii/S0041134508016023
DOI
10.1016/j.transproceed.2008.11.006
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soo Jin(김수진)
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Kim, Yu Seun(김유선) ORCID logo https://orcid.org/0000-0002-5105-1567
Chang, Hye Kyung(장혜경)
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/103495
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