Small bowel transplantation (SBT) either isolated or as a part of Multi-visceral is proven to be beneficial for patients with intestinal failure. Infectious complications especially fungal infections represent a major cause of morbidity and mortality in solid organ transplant (SOT) recipients. There are very limited data on invasive aspergillosis (IA) in SBT recipients.
A retrospective, descriptive study of the IA cases in SBT recipients at the UPMC. All SBT recipients 1996-2009 with positive culture for aspergillus species and computed tomography suspicious of aspergillus were included. Patients’ demographics, time and type of graft, immunosuppressive medications, acute rejections episodes, antirejection medications and cause of graft failure were collected.
During the study period 1996-2009 there were 282 SBT cases performed. Aspergillus species were isolated in 27 cases (9.5%). Twenty cases had multi-visceral transplant while 7 cases had isolated SBT. Aspergillus was isolated from the respiratory tract in 16/27 cases, sinus in 1 case, bone biopsy in 1 case, inguinal wound in 1 case, deep wound in 1 case, abdominal wound in 2 cases, skin biopsy in 1 case and unspecified sites in 4 cases. A. Fumagitus was the predominant species, isolated in 14 cases followed by A.niger, A.flavus and A. terreus with 3 cases each. A.versicolor in 2, A.glaucus and A. terazonus with 1 case each.
Twenty patients had at least 1 episode of acute rejection. Murmonab-CD3 (OKT3), steroids and alemtuzumab were used to treat rejection episodes. Aspergillosis was the documented to be the cause of death in 8/27(30%).
IA represents a major burden in SBT. Sinupulmonary aspergillosis is the commonest site of infection. Acute rejections and use of anti-rejection medication increase the risk of acquiring IA. IA carries very high mortality rate in SBT recipients.
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