Immune reconstitution syndrome-like entity in lung transplant recipients with invasive aspergillosis

Nina Singh, Jose F. Suarez, Robin Avery, Cornelia Lass-Flörl, Christian Geltner, Alessandro C. Pasqualotto, G. Marshall Lyon, Michelle Barron, Shahid Husain, Marilyn M. Wagener, Jose G. Montoya

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Incidence, characteristics, and risk-factors for invasive aspergillosis (IA)-associated immune reconstitution syndrome (IRS) in lung transplant recipients are not known. Methods: Patients comprised 68 lung transplant recipients with proven/probable IA followed for 12. months. IRS was defined based on previously proposed criteria. Results: In all, 7.3% (5/68) of the patients developed IRS based on aforementioned criteria, a median of 56. days after initiation of antifungal therapy. This entity was associated with heart-lung transplantation (p = 0.006), anti T-cell agent use (p = 0.003), discontinuation of calcineurin inhibitor agent (p = 0.002), and disseminated IA (p = 0.069). In a risk assessment model, IRS developed in 0% (0/55) of the patients with none of the aforementioned factors, 28.6% (2/7) with one, 33.3% (1/3) with two, and in 1/1 patient with 3 factors (X2 for trend p = 0.0001). Three out of 5 patients with IRS died and 2 of 3 deaths in this group were due to chronic rejection. Conclusions: Overall 7% of the lung transplant recipients with IA appear to develop an IRS-like entity. Clinically assessable factors can identify patients at risk for post-transplant IA-associated IRS. Deaths due to chronic rejection were significantly higher in patients with IRS than those without IRS.

Original languageEnglish (US)
Pages (from-to)109-113
Number of pages5
JournalTransplant Immunology
Volume29
Issue number1-4
DOIs
StatePublished - Dec 2013

Keywords

  • Aspergillosis
  • Immune reconstitution syndrome
  • Lung transplant

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Transplantation

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