1515. Invasive mold infections in lung and heart-lung transplant recipients clinical characteristics and predictors of 1-year mortality, a single center experience
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Invasive mold infections remain a major morbidity and mortality cause especially in lung (LT) and heart lung (HLT) transplant recipients. We report our experience with invasive mold infections (IMIs) over a 22 years period

Methods: All proven and probable IMIs in LT and HLT were identified between 1/1/1990 and 1/30/2012 at Stanford University Medical Center.

Clinical and demographic data were recorded at baseline, diagnosis and at 1 and 3 months. One-year mortality was also recorded.

We used log-rank test for categorical data and univariate cox analysis for continuous variables. Two distinct multivariate models were performed to predict one-year mortality. One included pre-diagnosis risk factors and the other post-diagnosis variables.  

Results: A total of 87 patients with IMI were identified. 63(72%) were infected with Aspergillus and 24(28%) with non-Aspergillus molds.

 The average age was 46±13.5 and 57(65.5%) were females. Single lung transplantation was performed in 26(30%), double lung in 38(44%), and heart lung in 23(26%) recipients.  CMV infection was present in 40(46.5%) of patients. OKT3, RATG or Daclizumab were used as induction immunosuppression in 62 (76.5%) patients. 30 (34.5%) patients were on itraconazole and 17(19%) were on voriconazole prophylaxis. Chronic rejection predated IMI in 30(34.5%) and 10 (11%) patients had acute rejection peri IMI diagnosis. Significant comorbidities were diabetes mellitus in 42(48.3%) and chronic kidney disease in 33(38%) patients.

 Only 15(17%) recipients were diagnosed within 90 days of transplantation. Most IMI affected the lung parenchyma 69(79%), Absolute neutrophil count was 5.9±4.8x103/mL. At diagnosis, 69 (79%) patients were symptomatic and only 13(18.8%) had the halo sign on CT.

 CKD (HR=2.13, SE= 0.73), chronic rejection (HR=2.3, SE= 0.81) and voriconazole prophylaxis (HR=2.35 , SE=0.93) were significant in the first model. Infection with a non-Aspergillus mold (HR=2.8,SE =1), presence of symptoms (HR=5.5, SE=3.4), and a dose of prednisone>5mg/day (HR=7.8, SE=7.9) were all associated with increased one-year mortality in multilogistic regression.

Conclusion: The presence of symptoms at diagnosis, a non-Aspergillus mold and a dose of prednisone of > 5 mg/day were associated with increased mortality in LT and HLT recipients with IMIs

Cristina Vazquez Guillamet, MD, Barnes Jewish Hospital- Washington University School of Medicine, St Louis, MO, Rodrigo Vazquez Guillamet, MD, University of New Mexico School of Medicine, Albuquerque, NM, Jose Suarez, MS, Universidad De La Sabana, Bogota, Colombia, Gundeep Dhillon, MD, Medicine, Stanford University School of Medicine, Stanford, CA and Jose G. Montoya, MD, Stanford University, Stanford, CA

Disclosures:

C. Vazquez Guillamet, None

R. Vazquez Guillamet, None

J. Suarez, None

G. Dhillon, None

J. G. Montoya, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.