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.
N1 - Funding Information:
Nina Singh has received research support from Pfizer, Inc. , and Astellas Pharma, US . Cornelia Lass-Flörl has received research support from Astellas Pharma, Gilead Sciences , Pfizer Inc., Schering Plough , and Merck Sharp and Dohme , advisor/consultant to Gilead Sciences, Merck Sharp and Dohme, Pfizer and Schering Plough and speaking fee from Gilead Sciences, Merck Sharp and Dohme, Pfizer, Astellas Pharma and Schering Plough. Christian Geltner has received speaking fee from Merck & Co, Inc. and Pfizer. Alessandro Pasqualotto has received research grants from Pfizer, Merck &Co, Inc., Bagó , and United Medical (Gilead) and has received speaking fee from Pfizer, Astellas, Merck &Co, and United Medical (Gilead). Michelle Barron has received research support from Pfizer, Inc., Merck & Co, Inc. and Astellas Pharma, US. Shahid Husain has received research grants from Pfizer, Inc., Merck & Co, Inc. and Astellas Pharma, US and has served on Expert panel for Pfizer and Merck. There are no conflict of interest disclosures for other authors.
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 -