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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Paniagua Martin, M. J. Marzoa Rivas, R. Barge Caballero, E. Grille Cancela, Z. Fernandez, C. J. Solla, M. Pedrosa, V. Rodriguez Fernandez, J. A. Herrera, J. M. Castro-Beiras, A. Crespo-Leiro, M. G. |
| Description | Country affiliation: Spain Author Affiliation: Paniagua Martin MJ ( Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain. MA.Jesus.Paniagua.Martin@sergas.es) |
| Abstract | BACKGROUND: The incidence of aspergillosis (ASP) after heart transplantation (HTx) is low (<4%-5%), but the mortality is high (>78%). AIM: To determine the incidence of ASP in the first 3 months post-HTx according to the type of prophylaxis and assess the tolerance to these regimens. METHODS: This retrospective study of 571 adult HTx patients engrafted from 1991 to December 2009 included 83% males with an overall group age of 54.9±11 years. Three types of prophylaxis were compared: group A was no prophylaxis (n=99; 1991-1994); group B, itraconazole for 3 months (n=352; 1995-November 2004); and group C, inhaled amphotericin for 3 months (n=120; December 2004-2009). The dependent variables were the presence and severity or tracheobronchitis and invasive/disseminated disease as well as, prognosis of Aspergillus infection and tolerance to the regimen. RESULTS: The incidences of aspergillosis were 5% in group A (n=5); 1.4% in group B (n=5); and 0% in group C. Significant differences were observed between groups A versus B (P=.030) and between groups A versus C (P=.013), but there were no differences between groups B versus C. In terms of severity, there were no significant differences among the five cases of tracheobronchitis (20% group A/80% group B), five of invasive/disseminated disease (80% group A/20% group B). There were two deaths (20%) from invasive/disseminated ASP at 0.67 months after diagnosis. The mean time from HTx to ASP was 0.98±0.40 months. There were no adverse effects associated with itraconazole, but they occurred in 3/120 patients (2.5%) treated with inhaled amphotericin, all of whom were on mechanical ventilation, developing respiratory failure requiring amphotericin withdrawal. CONCLUSIONS: Prophylaxis with itraconazole or inhaled amphotericin was effective for the prevention and severity of pulmonary ASP in the first 3 months post-HTx. Although the incidence of early ASP was low in our series, the 20% mortality rate justified the use of preventive measures. Tolerance to both prophylactic treatments was good. |
| File Format | HTM / HTML |
| ISSN | 00411345 |
| Issue Number | 8 |
| Volume Number | 42 |
| e-ISSN | 18732623 |
| Journal | Transplantation Proceedings |
| Language | English |
| Publisher | Elsevier |
| Publisher Date | 2010-10-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Transplantation__semicolon__medicine Amphotericin B Therapeutic Use Antifungal Agents Aspergillosis Prevention & Control Heart Transplantation Adverse Effects Itraconazole Adult Aged Administration & Dosage Female Humans Incidence Male Middle Aged Journal Article Research Support, Non-u.s. Gov't |
| Content Type | Text |
| Resource Type | Article |
| Subject | Transplantation Surgery |
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