Invasive pulmonary aspergillosis in heart transplant recipients: Two radiologic patterns with a different prognosis

Munoz, Patricia; Vena, Antonio; Ceron, Ines; Valerio, Maricela; Palomo, Jesus; Guinea, Jesils; Escribano, Pilar; Martinez-Selles, Manuel; Bouza, Emilio; PROMULGA Project Grp


BACKGROUND: Computed tomography (CT) findings can be used to classify invasive pulmonary aspergillosis (IPA) in 2 patterns: airway-invasive (AIR) or angioinvasive (ANG). METHODS: AIR-IPA was considered when the CT revealed peribronchial consolidation or a tree-in-bud pattern and ANG-IPA when a nodule, cavity, halo sign, infarct-shaped, or mass-like consolidation was found. We evaluated the correlation among IPA patterns on CT and outcomes in heart transplant (HT) recipients. RESULTS: The study included 27 HT recipients with a CT scan performed at the time of IPA diagnosis. The study interval was from 1988 to 2011. Ten AIR-IPA patients (37.1%) were compared with 17 ANG-IPA patients (62.9%). During the post-transplantation period before IPA developed, AIR patients required hemodialysis more frequently (40% vs 5.9%, p = 0.04). AIR patients also had more intercurrent bacterial pneumonia (23.5% vs 70%, p 0.001), and IPA was diagnosed later after onset of symptoms (2.7 vs 8.5 d, p = 0.09). After diagnosis, AIR-IPA patients required more mechanical ventilation (23.5% vs 90%, p 0.01) and had a higher related mortality rate (23.5% vs 70%, p = 0.04). CONCLUSIONS: Our study shows that the AIR pattern represents 37% of IPA episodes in HT recipients and is associated with a more protracted clinical presentation, later diagnosis, and higher mortality rate. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.

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Título según WOS: ID WOS:000342536200006 Not found in local WOS DB
Volumen: 33
Número: 10
Editorial: Elsevier Science Inc.
Fecha de publicación: 2014
Página de inicio: 1034
Página final: 1040


Notas: ISI