Risk factors for the development of invasive aspergillosis after kidney transplantation: Systematic review and meta-analysis.

Abstract

To investigate risk factors for invasive aspergillosis (IA) after kidney transplantation (KT), we conducted a systematic search in PubMed and EMBASE to identify studies published until June 2020. We included case-control or cohort design studies comprising KT recipients with a diagnosis of IA, defined according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria, and assessed risk factors for the development of IA. Random-effect models meta-analysis served to pool data. We identified eleven case-control studies (319 IA cases and 835 controls). There was an increased risk of IA among recipients with underlying chronic lung diseases (odds ratio [OR]=7.26; 95% confidence interval [CI]=1.05-50.06) and among those with diabetic nephropathy (OR=1.65; 95% CI=1.10-2.48). Requiring posttransplant hemodialysis (OR=3.69; 95% CI=2.13-6.37) or surgical reintervention (OR=6.28; 95% CI=1.67-23.66) were also associated with an increased risk. Moreover, a positive link was identified between IA and posttransplant bacterial infection (OR=7.51; 95% CI=4.37-12.91), respiratory tract viral infection (OR=7.75; 95% CI=1.60-37.57), cytomegalovirus infection or disease (OR=2.67; 95% CI=1.12-6.32), and acute graft rejection (OR=3.01; 95% CI=1.78-5.09). In contrast, receiving a kidney from a living donor was associated with a reduced risk (OR=0.65; 95% CI=0.46-0.93). KT recipients that accumulate several of these conditions should be closely monitored and a low threshold of suspicion for IA should be maintained. Future studies should explore the benefit of mold-active prophylaxis to this subgroup of KT recipients at highest risk.