Invasive aspergillosis in liver transplant recipients in the current era

Muneyoshi Kimura; Matteo Rinaldi; Sagar Kothari; Maddalena Giannella; Shweta Anjan; Yoichiro Natori; Pakpoom Phoompoung; Emily Gault; Jonathan Hand; Matilde D'Asaro; Dionysios Neofytos; Nicolas J. Mueller; Andreas E. Kremer; Tereza Rojko; Marija Ribnikar; Fernanda P. Silveira; Joshua Kohl; Angela Cano; Julian Torre-Cisneros; Rafael San-Juan; Jose Maria Aguado; Armaghan e.Rehman Mansoor; Ige Abraham George; Alessandra Mularoni; Giovanna Russelli; Me Linh Luong; Yamama A. AlJishi; Maram N. AlJishi; Bassem Hamandi; Nazia Selzner; Shahid Husain

doi:10.1016/j.ajt.2024.05.016

Invasive aspergillosis in liver transplant recipients in the current era

Muneyoshi Kimura, Matteo Rinaldi, Sagar Kothari, Maddalena Giannella, Shweta Anjan, Yoichiro Natori, Pakpoom Phoompoung, Emily Gault, Jonathan Hand, Matilde D'Asaro, Dionysios Neofytos, Nicolas J. Mueller, Andreas E. Kremer, Tereza Rojko, Marija Ribnikar, Fernanda P. Silveira, Joshua Kohl, Angela Cano, Julian Torre-Cisneros, Rafael San-JuanJose Maria Aguado, Armaghan e.Rehman Mansoor, Ige Abraham George, Alessandra Mularoni, Giovanna Russelli, Me Linh Luong, Yamama A. AlJishi, Maram N. AlJishi, Bassem Hamandi, Nazia Selzner, Shahid Husain

Internal Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.

Original language	English
Pages (from-to)	2092-2107
Number of pages	16
Journal	American Journal of Transplantation
Volume	24
Issue number	11
DOIs	https://doi.org/10.1016/j.ajt.2024.05.016
State	Published - Nov 2024

Bibliographical note

Publisher Copyright:
© 2024

Funding

Swiss patients’ data were retrieved from the Swiss Transplant Cohort Study. The Swiss Transplant Cohort Study is supported by the Swiss National Science Foundation (SNSF, http://www.snf.ch), Unimedsuisse (https://www.unimedsuisse.ch), and the Transplant Centers.

Funders	Funder number
Swiss Transplant Cohort Study
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung

Keywords

invasive aspergillosis
liver transplantation
targeted antifungal prophylaxis

ASJC Scopus subject areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

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10.1016/j.ajt.2024.05.016

Cite this

Kimura, M., Rinaldi, M., Kothari, S., Giannella, M., Anjan, S., Natori, Y., Phoompoung, P., Gault, E., Hand, J., D'Asaro, M., Neofytos, D., Mueller, N. J., Kremer, A. E., Rojko, T., Ribnikar, M., Silveira, F. P., Kohl, J., Cano, A., Torre-Cisneros, J., ... Husain, S. (2024). Invasive aspergillosis in liver transplant recipients in the current era. American Journal of Transplantation, 24(11), 2092-2107. https://doi.org/10.1016/j.ajt.2024.05.016

@article{fae94ffe35c94f72ac14caedc3aa4967,

title = "Invasive aspergillosis in liver transplant recipients in the current era",

abstract = "Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13\%). Twelve-week all-cause mortality of IA was 37\%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.",

keywords = "invasive aspergillosis, liver transplantation, targeted antifungal prophylaxis",

author = "Muneyoshi Kimura and Matteo Rinaldi and Sagar Kothari and Maddalena Giannella and Shweta Anjan and Yoichiro Natori and Pakpoom Phoompoung and Emily Gault and Jonathan Hand and Matilde D'Asaro and Dionysios Neofytos and Mueller, \{Nicolas J.\} and Kremer, \{Andreas E.\} and Tereza Rojko and Marija Ribnikar and Silveira, \{Fernanda P.\} and Joshua Kohl and Angela Cano and Julian Torre-Cisneros and Rafael San-Juan and Aguado, \{Jose Maria\} and Mansoor, \{Armaghan e.Rehman\} and George, \{Ige Abraham\} and Alessandra Mularoni and Giovanna Russelli and Luong, \{Me Linh\} and AlJishi, \{Yamama A.\} and AlJishi, \{Maram N.\} and Bassem Hamandi and Nazia Selzner and Shahid Husain",

note = "Publisher Copyright: {\textcopyright} 2024",

year = "2024",

month = nov,

doi = "10.1016/j.ajt.2024.05.016",

language = "English",

volume = "24",

pages = "2092--2107",

number = "11",

}

Kimura, M, Rinaldi, M, Kothari, S, Giannella, M, Anjan, S, Natori, Y, Phoompoung, P, Gault, E, Hand, J, D'Asaro, M, Neofytos, D, Mueller, NJ, Kremer, AE, Rojko, T, Ribnikar, M, Silveira, FP, Kohl, J, Cano, A, Torre-Cisneros, J, San-Juan, R, Aguado, JM, Mansoor, AER, George, IA, Mularoni, A, Russelli, G, Luong, ML, AlJishi, YA, AlJishi, MN, Hamandi, B, Selzner, N & Husain, S 2024, 'Invasive aspergillosis in liver transplant recipients in the current era', American Journal of Transplantation, vol. 24, no. 11, pp. 2092-2107. https://doi.org/10.1016/j.ajt.2024.05.016

TY - JOUR

T1 - Invasive aspergillosis in liver transplant recipients in the current era

AU - Kimura, Muneyoshi

AU - Rinaldi, Matteo

AU - Kothari, Sagar

AU - Giannella, Maddalena

AU - Anjan, Shweta

AU - Natori, Yoichiro

AU - Phoompoung, Pakpoom

AU - Gault, Emily

AU - Hand, Jonathan

AU - D'Asaro, Matilde

AU - Neofytos, Dionysios

AU - Mueller, Nicolas J.

AU - Kremer, Andreas E.

AU - Rojko, Tereza

AU - Ribnikar, Marija

AU - Silveira, Fernanda P.

AU - Kohl, Joshua

AU - Cano, Angela

AU - Torre-Cisneros, Julian

AU - San-Juan, Rafael

AU - Aguado, Jose Maria

AU - Mansoor, Armaghan e.Rehman

AU - George, Ige Abraham

AU - Mularoni, Alessandra

AU - Russelli, Giovanna

AU - Luong, Me Linh

AU - AlJishi, Yamama A.

AU - AlJishi, Maram N.

AU - Hamandi, Bassem

AU - Selzner, Nazia

AU - Husain, Shahid

PY - 2024/11

Y1 - 2024/11

N2 - Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.

AB - Invasive aspergillosis (IA) is a rare but fatal disease among liver transplant recipients (LiTRs). We performed a multicenter 1:2 case-control study comparing LiTRs diagnosed with proven/probable IA and controls with no invasive fungal infection. We included 62 IA cases and 124 matched controls. Disseminated infection occurred only in 8 cases (13%). Twelve-week all-cause mortality of IA was 37%. In multivariate analyses, systemic antibiotic usage (adjusted odds ratio [aOR], 4.74; P = .03) and history of pneumonia (aOR, 48.7; P = .01) were identified as independent risk factors associated with the occurrence of IA. Moreover, reoperation (aOR, 5.99; P = .01), systemic antibiotic usage (aOR, 5.03; P = .04), and antimold prophylaxis (aOR, 11.9; P = .02) were identified as independent risk factors associated with the occurrence of early IA. Among IA cases, Aspergillus colonization (adjusted hazard ratio [aHR], 86.9; P < .001), intensive care unit stay (aHR, 3.67; P = .02), disseminated IA (aHR, 8.98; P < .001), and dialysis (aHR, 2.93; P = .001) were identified as independent risk factors associated with 12-week all-cause mortality, while recent receipt of tacrolimus (aHR, 0.11; P = .001) was protective. Mortality among LiTRs with IA remains high in the current era. The identified risk factors and protective factors may be useful for establishing robust targeted antimold prophylactic and appropriate treatment strategies against IA.

KW - invasive aspergillosis

KW - liver transplantation

KW - targeted antifungal prophylaxis

UR - https://www.scopus.com/pages/publications/85200253600

UR - https://www.scopus.com/inward/citedby.url?scp=85200253600&partnerID=8YFLogxK

U2 - 10.1016/j.ajt.2024.05.016

DO - 10.1016/j.ajt.2024.05.016

M3 - Article

C2 - 38801991

AN - SCOPUS:85200253600

SN - 1600-6135

VL - 24

SP - 2092

EP - 2107

JO - American Journal of Transplantation

JF - American Journal of Transplantation

IS - 11

ER -

Invasive aspergillosis in liver transplant recipients in the current era

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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