Invasive aspergillosis among heart transplant recipients: a 24-year perspective.
BACKGROUND
Invasive aspergillosis is a well-known complication in severely immunosuppressed patients, including heart transplant recipients, and associated mortality is high. Despite the severity of the disease in this population, few recent series with secular trends have addressed the problem.


METHODS
We performed a descriptive study of 479 consecutive heart transplant recipients from 1988 to 2011 in a single institution.


RESULTS
Overall invasive aspergillosis incidence in heart transplant recipients was 6.5% (31 of 479). Incidence decreased from 8.7% (24 of 277) in the period 1988 to 2000 (historical cohort) to 3.5% (7 of 202) afterward (p = 0.02); 4 of the 7 cases were in the context of an outbreak. The most common presentation was lung infection, but episodes occurring >3 months after transplantation (late aspergillosis) showed a higher frequency of disseminated disease and involvement of the central nervous system and of atypical sites compared with early (first 3 months) episodes. Related mortality was 36%, with a significant decrease between the historical cohort and the present cohort: 46% vs 0% (p = 0.04) and a trend toward lower related death in early vs late cases (26% vs 63%, p = 0.09).


CONCLUSIONS
In our series, both incidence and mortality associated with invasive aspergillosis in heart transplant recipients showed a decrease in recent years. Careful environmental management and targeted anti-fungal prophylaxis may minimize the incidence of invasive aspergillosis in this setting.
['Muñoz|Patricia|P|', 'Cerón|Ines|I|', 'Valerio|Maricela|M|', 'Palomo|Jesús|J|', 'Villa|Adolfo|A|', 'Eworo|Alia|A|', 'Fernández-Yáñez|Juan|J|', 'Guinea|Jesús|J|', 'Bouza|Emilio|E|']
D000328:Adult D000368:Aged D000935:Antifungal Agents D015331:Cohort Studies D005260:Female D006084:Graft Rejection D016027:Heart Transplantation D006801:Humans D007166:Immunosuppressive Agents D015994:Incidence D055744:Invasive Pulmonary Aspergillosis D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate
invasive aspergillosis heart transplantation anti-fungal prophylaxis Aspergillus spp