Overview

Invasive aspergillosis is one of the most devastating infectious complications of organ transplantation. The incidence of this infection ranges between 1-2% in liver and kidney allograft recipients, 5% heart recipients, and up to 15% of lung recipients. The portal of entry in the vast majority of cases is the respiratory tract through environmental exposures. Once in lung tissue, Aspergillus causes ulceration, necrosis, and tissue and blood vessel invasion. Once angioinvasive, dissemination to distant sites occurs. While, historically, most infections present in the first three months following transplantation, recent trends suggest that late onset infections are occurring more frequently than in the past. Risk factors for invasive disease include prolonged operation time, renal failure, neutropenia, CMV infection, and heavy immunosuppression, especially high dose corticosteroids and OKT3. Additional risk factors for liver recipients include allograft dysfunction, fulminant hepatic failure before transplantation, and re-transplantation. For lung recipients, airway specimen cultures positive for Aspergillus and obliterative bron-chiolitis are risk factors.

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