TY - JOUR T1 - Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing? JO - Revista Portuguesa de Cardiologia T2 - AU - Flores-Umanzor,Eduardo AU - Ivey-Miranda,Juan Betuel AU - Pujol-Lopez,Margarida AU - Cepas-Guillen,Pedro AU - Fernandez-Valledor,Andrea AU - Caldentey,Guillen AU - Farrero,Marta AU - García,Ana AU - Sitges,Marta AU - Perez-Villa,Felix AU - Moreno,Asunción AU - Andrea,Rut AU - Castel,María A. SN - 08702551 M3 - 10.1016/j.repc.2019.08.004 DO - 10.1016/j.repc.2019.08.004 UR - https://www.revportcardiol.org/pt-invasive-pulmonary-aspergillosis-in-heart-articulo-S0870255119304639 AB - IntroductionInfection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). ObjectivesTo establish the characteristics of IPA infection in HT recipients and their outcomes in our center. MethodsAmong 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. ResultsAll cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. ConclusionsIPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival. ER -