188宝金博页面版

Risk factors for invasive fungal disease in hearttransplant recipientsAlexander S. Rabin, MD, a Michael M. Givertz, MD, b Gregory S. Couper, MD, cMargaret M. Shea, BA, a Driele Peixoto, MD, a Deborah S. Yokoe, MD, aLindsey R. Baden, MD, a Francisco M. Marty, MD, a and Sophia Koo, MD aFrom thea Division of Infectious Diseases; b Cardiovascular Division; and the c Division of Cardiac Surgery, Brigham andWomen’s Hospital, Boston, Massachusetts.KEYWORDS:invasive fungaldisease;heart transplantation;risk factors;Aspergillus;CandidaBACKGROUND: Heart transplant (HT) recipients are at risk for invasive fungal disease (IFD), a morbidand potentially fatal complication.METHODS: We performed a retrospective cohort study to evaluate the incidence and risk factors for IFDin HT recipients from 1995 to 2012 at a single center. IFD cases were classified as proven or probableIFD according to current consensus definitions of the European Organization for Research andTreatment of Cancer/Mycoses Study Group. We calculated IFD incidence rates and used Coxproportional hazards models to determine IFD risk factors.RESULTS: Three hundred sixty patients underwent HT during the study period. The mostcommon indications were dilated (39%) and ischemic (37%) cardiomyopathy. There were 23(6.4%) cases of proven (21) or probable (2) IFD, for a cumulative incidence rate of 1.23 per 100person-years (95% CI 0.78 to 1.84). Candida (11) and Aspergillus (5) were the most commonetiologic fungi. Thirteen cases (56%) occurred within 3 months of HT, with a 3-month incidenceof 3.8% (95% CI 2.2 to 6.4). Delayed chest closure (HR 3.3, 95% CI 1.4 to 7.6, p ¼ 0.01) and theaddition of OKT3, anti-thymocyte globulin or daclizumab to standard corticosteroid inductiontherapy (HR 2.7, 95% CI 1.1 to 6.2, p ¼ 0.02) were independently associated with an increasedrisk of IFD.CONCLUSIONS: IFD incidence was greatest within the first 3 months post-HT, largelyreflecting early surgical-site and nosocomial Candida and Aspergillus infections. Patientsreceiving additional induction immunosuppression or delayed chest closure were at increasedrisk for IFD. Peri-transplant anti-fungal prophylaxis should be considered in this subset of HTrecipients.J Heart Lung Transplant 2015;34:227–232r 2015 International Society for Heart and Lung Transplantation. All rights reserved.Heart transplant (HT) recipients are at risk for invasivefungal disease (IFD), a morbid and potentially fatalcomplication of transplantation. Surveillance studies ofheart and other solid-organ transplant (SOT) recipients havesuggested an overall IFD incidence of 1% to 12% with anattributable mortality of between 35% and 75%. 1–7 Somestudies have explored empirical anti-fungal prophylaxisafter HT, 6,8 but data regarding IFD incidence, timing andrisk factors in the HT population are very limited. In thisstudy, we sought to estimate IFD incidence and identify IFDrisk factors in a cohort of HT patients to identify patientswho may benefit from anti-fungal prophylaxis.http://www.jhltonline.org1053-2498/$-see front matter r 2015 International Society for Heart and Lung Transplantation. All rights reserved.http://dx.doi.org/10.1016/j.healun.2014.09.036E-mail address: arabin@partners.orgReprint requests: Alexander Rabin, MD, Department of Medicine,Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115.Telephone: þ508-308-8962. Fax: þ617-732-6829.