非アスパラガス侵襲性糸状菌感染症：肝移植レシピエントにおけるフランス全国レトロスペクティブ症例対照研究、2007-2021年
Cléa Melenotte1,2, Coralie Le Hyaric3, Céline Guichon4
1Université Paris Cité, Hôpital Universitaire Necker-Enfants malades, Service de Maladies Infectieuses et Tropicales, Assistance Publique des Hôpitaux de Paris, 75743 PARIS CEDEX 15, France.
Background:
Non-Aspergillus invasive mould infections (IMIs) are emerging in immunocompromised patients, and liver is the second most commonly organ transplanted worldwide.
Methods:
We conducted a multicenter retrospective case-control (1:1) study of liver transplant (LT) recipients diagnosed with non-Aspergillus IMIs in France between January 2007 and December 2021.
Results:
We identified 27/14 332 (0.18%) LT recipients with non-Aspergillus IMIs. Mucorales spp. (48%) were the most common pathogens, followed by Scedosporium spp. (14%), Fusarium spp. (14%), and other IMIs (25%). Lungs were the primary infection site, followed by soft tissues, abdomen, brain, sinuses, heart, and bone. Multivariate analysis showed that a Model for End-stage Liver Disease score > 20 prior to transplantation and primary antifungal prophylaxis (with echinocandins or fluconazole) tended to increase the risk of non-Aspergillus IMIs by nearly threefold ((adjusted Odd Ratio (aOR): 3.73, 95% Confidence Interval (CI) [0.90-15.45], P = .07) and (aOR: 3.93; 95% CI [0.94-16.42], P = .06), respectively). The 6-month mortality rate was 55%. In a Cox survival model, non-Aspergillus IMIs were associated with a threefold increase in mortality risk (Hazard Ratio (HR) : 3.82 [2.01-7.26] P < .001).
Conclusion:
Non-Aspergillus IMIs are rare but highly fatal infections whose early diagnosis in high-risk liver-transplanted patients is essential. Whether or not recently available molecular tools for diagnosing non-Aspergillus IMIs will improve their prognosis in the liver transplantation setting remains to be studied.
