ASPERGILLOSIS AFTER PULMONARY, CARDIAC AN D RENAL-TRANSPLANTATION

The increase of organ transplantations during the last decades conjoin tly with the prescription of heavy immunosuppressive drugs, has led to an increased incidence of new invasive aspergillosis(IA). This study is a report of the Broussais Hospital experience from 1968 to 1993 on kidney, heart and heart and lungs transplantations. It concerns 21 IA cases. Incidence was 0,5 % for kidney, 4,5% for heart and 18 % for hea rt and lungs transplantations. The most important risk factors were th e increase of immunosuppressive therapy (66 % of the cases), neutropen ia (19 %), and renovation of the hospital wards (36 %). Lung was the m ost frequent site of infection (95 % of the cases), clinical symptoms were no significant. Diagnosis procedures were realised on biopsy (23 %) and on bronchoalveolar lavage (66 %). Usual amphotericin B treatmen t was disapointing : mortality rate of 77 %, the liposomal preparation of the drug seemed to be more efficient : mortality rate of 50 %. Itr aconazole appeared to be used in succession with a careful adaptation of posology. Prophylactic amphotericin B in a local way (sprays and ae rosols) led to a good efficiency jointly with the patient isolation du ring constructions in the hospital area.