TY - JOUR
T1 - Immune reconstitution syndrome-like entity in lung transplant recipients with invasive aspergillosis
AU - Singh, Nina
AU - Suarez, Jose F.
AU - Avery, Robin
AU - Lass-Flörl, Cornelia
AU - Geltner, Christian
AU - Pasqualotto, Alessandro C.
AU - Lyon, G. Marshall
AU - Barron, Michelle
AU - Husain, Shahid
AU - Wagener, Marilyn M.
AU - Montoya, Jose G.
PY - 2013/12
Y1 - 2013/12
N2 - 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.
AB - 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.
KW - Aspergillosis
KW - Immune reconstitution syndrome
KW - Lung transplant
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U2 - 10.1016/j.trim.2013.09.007
DO - 10.1016/j.trim.2013.09.007
M3 - Article
C2 - 24076039
AN - SCOPUS:84897095841
VL - 29
SP - 109
EP - 113
JO - Transplant Immunology
JF - Transplant Immunology
SN - 0966-3274
IS - 1-4
ER -