SHORT COMMUNICATION
Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing?
Aspergilose pulmonar invasiva em doentes submetidos a transplante cardíaco: estará a mortalidade a diminuir?
Eduardo Flores-Umanzora,
, Juan Betuel Ivey-Mirandaa,b, Margarida Pujol-Lopeza, Pedro Cepas-Guillena, Andrea Fernandez-Valledora, Guillen Caldenteya, Marta Farreroa, Ana Garcíaa, Marta Sitgesa, Felix Perez-Villaa, Asunción Morenoc, Rut Andreaa, María A. Castel Mda
Corresponding author
a Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
b Department of Cardiology, Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
c Infectious Disease Department, Hospital Clínic, IDIBAPS, Spain
Read
3137
Timeswas read the article
1351
Total PDF
1786
Total HTML
Share statistics
array:25 [ "pii" => "S2174204921000106" "issn" => "21742049" "doi" => "10.1016/j.repce.2019.02.018" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1644" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2021;40:57-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "en" => array:20 [ "pii" => "S0870255120304625" "issn" => "08702551" "doi" => "10.1016/j.repc.2019.02.017" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1644" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2021;40:57-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">SHORT COMMUNICATION</span>" "titulo" => "Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "61" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aspergilose pulmonar invasiva em doentes submetidos a transplante cardíaco: estará a mortalidade a diminuir?" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 614 "Ancho" => 1250 "Tamanyo" => 106246 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing multiple nodular opacities and an incipient halo sign secondary to invasive pulmonary aspergillosis (yellow arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo Flores-Umanzor, Juan Betuel Ivey-Miranda, Margarida Pujol-Lopez, Pedro Cepas-Guillen, Andrea Fernandez-Valledor, Guillen Caldentey, Marta Farrero, Ana García, Marta Sitges, Felix Perez-Villa, Asunción Moreno, Rut Andrea, María A. Castel Md" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Flores-Umanzor" ] 1 => array:2 [ "nombre" => "Juan Betuel" "apellidos" => "Ivey-Miranda" ] 2 => array:2 [ "nombre" => "Margarida" "apellidos" => "Pujol-Lopez" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "Cepas-Guillen" ] 4 => array:2 [ "nombre" => "Andrea" "apellidos" => "Fernandez-Valledor" ] 5 => array:2 [ "nombre" => "Guillen" "apellidos" => "Caldentey" ] 6 => array:2 [ "nombre" => "Marta" "apellidos" => "Farrero" ] 7 => array:2 [ "nombre" => "Ana" "apellidos" => "García" ] 8 => array:2 [ "nombre" => "Marta" "apellidos" => "Sitges" ] 9 => array:2 [ "nombre" => "Felix" "apellidos" => "Perez-Villa" ] 10 => array:2 [ "nombre" => "Asunción" "apellidos" => "Moreno" ] 11 => array:2 [ "nombre" => "Rut" "apellidos" => "Andrea" ] 12 => array:2 [ "nombre" => "María A." "apellidos" => "Castel Md" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204921000106" "doi" => "10.1016/j.repce.2019.02.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921000106?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120304625?idApp=UINPBA00004E" "url" => "/08702551/0000004000000001/v1_202101220721/S0870255120304625/v1_202101220721/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S217420492100009X" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.04.013" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1643" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2021;40:63.e1-63.e5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Quadricuspid aortic valve with a hidden left ostium: Case report and literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "63.e1" "paginaFinal" => "63.e5" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Válvula aórtica quadricúspide com <span class="elsevierStyleItalic">ostium</span> coronário esquerdo oculto: caso clínico e revisão da literatura" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2373 "Ancho" => 1582 "Tamanyo" => 249243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Left: the seven (A-G) anatomic types of quadricuspid valves described by Hurwitz and Roberts. Type H was added later by Vali et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a>. The most common is type B and the rarest is type D. Right: the simplified classification of Nakamura et al., based on the position of the supernumerary cusp. L: left coronary cusp; N: non-coronary cusp; R: right coronary cusp; S: supernumerary cusp. Red circles identify the case presented in this report.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Filipe R. Soares, Carlos Branco, Gonçalo F. Coutinho, David Prieto, Manuel J. Antunes" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Filipe R." "apellidos" => "Soares" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Branco" ] 2 => array:2 [ "nombre" => "Gonçalo F." "apellidos" => "Coutinho" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Prieto" ] 4 => array:2 [ "nombre" => "Manuel J." "apellidos" => "Antunes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255120304613" "doi" => "10.1016/j.repc.2018.04.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120304613?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420492100009X?idApp=UINPBA00004E" "url" => "/21742049/0000004000000001/v1_202102241115/S217420492100009X/v1_202102241115/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204921000076" "issn" => "21742049" "doi" => "10.1016/j.repce.2021.02.001" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "1640" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2021;40:53-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Commentary</span>" "titulo" => "Breaking down the barriers: Re-evaluating risk of MRI in patients with cardiac implantable electronic devices via collaborative practice" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "55" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Quebrando as barreiras: reavaliar o risco da ressonância magnética cardiaca em doentes com <span class="elsevierStyleItalic">devices</span> eletrónicos implantados através de trabalho de equipa" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "João B. Augusto, Charlotte Manisty" "autores" => array:2 [ 0 => array:2 [ "nombre" => "João B." "apellidos" => "Augusto" ] 1 => array:2 [ "nombre" => "Charlotte" "apellidos" => "Manisty" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255120304583" "doi" => "10.1016/j.repc.2020.11.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255120304583?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921000076?idApp=UINPBA00004E" "url" => "/21742049/0000004000000001/v1_202102241115/S2174204921000076/v1_202102241115/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">SHORT COMMUNICATION</span>" "titulo" => "Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "61" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Flores-Umanzor, Juan Betuel Ivey-Miranda, Margarida Pujol-Lopez, Pedro Cepas-Guillen, Andrea Fernandez-Valledor, Guillen Caldentey, Marta Farrero, Ana García, Marta Sitges, Felix Perez-Villa, Asunción Moreno, Rut Andrea, María A. Castel Md" "autores" => array:13 [ 0 => array:4 [ "nombre" => "Eduardo" "apellidos" => "Flores-Umanzor" "email" => array:1 [ 0 => "ejfu0209@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan Betuel" "apellidos" => "Ivey-Miranda" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Margarida" "apellidos" => "Pujol-Lopez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Pedro" "apellidos" => "Cepas-Guillen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Andrea" "apellidos" => "Fernandez-Valledor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Guillen" "apellidos" => "Caldentey" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Marta" "apellidos" => "Farrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Ana" "apellidos" => "García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Marta" "apellidos" => "Sitges" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Felix" "apellidos" => "Perez-Villa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 10 => array:3 [ "nombre" => "Asunción" "apellidos" => "Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 11 => array:3 [ "nombre" => "Rut" "apellidos" => "Andrea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 12 => array:3 [ "nombre" => "María A." "apellidos" => "Castel Md" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Cardiology Department, Cardiovascular Institute, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiology, Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Infectious Disease Department, Hospital Clínic, IDIBAPS, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aspergilose pulmonar invasiva em doentes submetidos a transplante cardíaco: estará a mortalidade a diminuir?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 614 "Ancho" => 1250 "Tamanyo" => 106246 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing multiple nodular opacities and an incipient halo sign secondary to invasive pulmonary aspergillosis (yellow arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infection remains a major complication among transplant recipients, causing approximately 20% of deaths in the first year after transplantation, as well as being a major cause of long-term morbidity and mortality. In solid organ transplants, such as cardiac transplantation, for which immunosuppressants are prescribed indefinitely, physicians and patients perpetually negotiate the delicate balance between the risks of graft rejection and infection.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> In this immunosuppressed population, <span class="elsevierStyleItalic">Aspergillus species</span> are opportunistic pathogens that can cause aggressive infections including sinusitis, tracheobronchitis, pneumonia, necrotizing cellulitis, brain abscess, and disseminated disease. In heart transplant (HT) recipients, <span class="elsevierStyleItalic">Aspergillus</span> spp. have been reported as the most common cause of invasive fungal infection and frequently causes pneumonia<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> with a high attributable mortality, ranging from 53% to 78%.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> Although invasive pulmonary aspergillosis (IPA) is a serious disease in this population, little is known about its natural history. The aim of this study was to further establish the characteristics of IPA infections and their outcomes in our setting.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a retrospective chart review of patients who underwent HT at our center between 1998 and 2016 and subsequently developed invasive pulmonary aspergillosis (IPA). Cases were identified according to the clinical practice guidelines of the Infectious Diseases Society of America for IPA<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and the revised EORTC/MSG criteria<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> for defining invasive fungal infection, including IPA. The diagnosis was considered definite when the patient had positive histology and culture of a sample obtained from the same site, or negative histology (or not performed) and positive culture results of a sample obtained by protocol-specified invasive techniques such as bronchoalveolar lavage (BAL). A serum galactomannan index of 1 or higher was regarded as positive and suggested a diagnosis of IPA.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Data collection included age, gender, primary cardiac diagnosis, date of transplantation, immunosuppressive regimen, cytomegalovirus serological status, antifungal prophylaxis, known risk factors for IPA (including neutropenia), radiographic features, serum galactomannan level, bronchoscopy and microbiology data (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At our institution, all patients by protocol receive induction therapy with basiliximab and high doses of corticosteroids. Basiliximab is administered 4-6 hours after delivery of the extracorporeal pump. The initiation of calcineurin inhibitors is delayed until day 3 post-HT. Maintenance immunosuppressive therapy consists of corticosteroids, calcineurin inhibitors and cell cycle inhibitors. This regimen is based on the recommendations of the International Society of Heart and Lung Transplantation guidelines for the care of HT recipients.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In our HT protocol, all patients without risk factors for infection by filamentous fungi are administered fluconazole 100 mg/day during the first month, from day 1 post-transplant. Patients at risk for infection by filamentous fungi (at least one of the following risk factors: administration of immunosuppression; acute renal failure requiring hemodialysis; colonization by filamentous fungi such as <span class="elsevierStyleItalic">Aspergillus</span>; retransplantation or double transplantation [heart and kidney or heart and liver]) receive antifungal prophylaxis with liposomal amphotericin B or micafungin.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In all patients under antifungal prophylaxis, fungal culture and staining with calcium fluoride from sputum or respiratory secretions, chest X-rays and blood antigen for <span class="elsevierStyleItalic">Aspergillus</span> are performed once a week while hospitalized. If the chest radiography is doubtful, high-resolution chest computed tomography (CT) is performed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After hospital discharge, patients are followed at our center every month for the first six months after HT, every two months from the sixth to the twelfth month, and then every six months indefinitely. At each visit a thorough clinical assessment is performed including routine laboratory analyses and a chest X-ray.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of 328 HTs performed between 1998 and 2016, five cases of IPA were identified. All cases were male, with a mean age of 62 years (range 59-71 years). The most common indication for HT was nonischemic dilated cardiomyopathy. Antifungal prophylaxis was started in all patients, but two patients did not complete the course since IPA was diagnosed within 30 days of HT. One patient required prophylaxis with micafungin due to acute renal failure.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The median time from transplantation at diagnosis was 55 days. Productive cough was reported as the main symptom in two patients, one patient presented atypical chest pain and the two others were asymptomatic. In one of the asymptomatic patients the diagnosis was suspected from abnormal findings (unilateral nodular opacities) on the chest X-ray during a monthly protocol follow-up visit. In all patients, the imaging assessment was based on chest radiography and chest CT. The most commonly reported radiological abnormality was multiple nodular opacities in both imaging techniques, as shown in <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>. Halo sign was observed in one case (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>b). Serum galactomannan level was abnormally high in three of the five patients. Bronchoscopy was performed in all patients and <span class="elsevierStyleItalic">A. fumigatus</span> was isolated in BAL culture in four cases. <span class="elsevierStyleItalic">Aspergillus</span> was identified by polymerase chain reaction (PCR) in one patient in whom nodular lesions on the chest X-ray aroused suspicion of IPA.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Initial antifungal treatment included amphotericin in four patients, subsequently changed to voriconazole in three cases, and posaconazole in one patient, with total treatment lasting an average of 12 months. Two patients required the addition of caspofungin and one of anidulafungin as salvage therapy. Neutropenia was found in only one patient. Renal failure, defined as creatinine >1.5 mg/dl, was observed in two patients, and concurrent cytomegalovirus (CMV) infection occurred in three patients. All patients survived after a mean follow-up of 18 months.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Since the introduction of HT as a therapeutic modality for end-stage heart failure in 1968, <span class="elsevierStyleItalic">Aspergillus</span> has been recognized as a major opportunistic pathogen with a high attributable mortality.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Our series of five IPA cases show unusually low mortality. There are several possible reasons for this. First, the number of reported cases is small, however 100% survival seems too optimistic and some fatality would be expected among them. Second, two patients were asymptomatic at the time of diagnosis, both with negative serum galactomannan, and hence treatment was initiated early. Also, four patients received combined treatment with two antifungals and only one patient was treated with just one drug.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The known risk factors for IPA in HT recipients include isolation of <span class="elsevierStyleItalic">A. fumigatus</span> in respiratory tract cultures prior to HT, reoperation, CMV disease, post-transplant hemodialysis, and cases of IPA in the institution two months before the transplant.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> In the study by Muñoz et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> IPA-related mortality was 11/17 (65%), and total mortality was 17/27 (63%), but this cohort presented a high proportion of risk factors for IPA – hemodialysis 19%, bacterial infection 63%, and rejection episode 44%. Also in this cohort, 82% of patients received either OKT3 or antithymocyte globulin as induction therapy. As is known, the stronger the immunosuppression, the higher the risk of infection. None of our patients needed hemodialysis, nor were there any rejection episodes requiring an increase in immunosuppression. Likewise, our patients received basiliximab instead of OKT3 or antithymocyte globulin. Basiliximab is associated with fewer infections overall than OKT3 or antithymocyte globulin in solid organ transplantation.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Although this case series may suffer from publication bias, we consider our results to be justified by early diagnosis based on serum galactomannan level and early bronchoscopy followed by initiation of aggressive treatment, as well as the patients’ clinical characteristics. Our findings can be attributed to improved outcomes resulting from early diagnosis, as has been demonstrated in patients with hematological malignancy and invasive fungal infection.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally, it seems clear that, as in many other fields of medicine, the prognosis of these patients is improving as more is learned about complications. Moreover, newer diagnostic techniques enable earlier initiation of treatment with modern therapeutic strategies. As Montoya et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> concluded, patients suffering IPA in recent years may have a better prognosis than those treated before. Is this the time that IPA mortality begins to fall?</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0075" class="elsevierStylePara elsevierViewall">IPA is a potentially lethal complication after HT. An early diagnosis and prompt initiation of aggressive treatment are the cornerstone for better survival.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1470839" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1339494" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1470840" "titulo" => "Resumo" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusões" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1339493" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-07" "fechaAceptado" => "2019-02-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1339494" "palabras" => array:3 [ 0 => "Heart transplantation" 1 => "Invasive pulmonary aspergillosis" 2 => "Immunosuppression" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec1339493" "palabras" => array:3 [ 0 => "Transplante cardíaco" 1 => "Aspergilose pulmonar invasiva" 2 => "Imunossupressão" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus species can have various clinical presentations including invasive pulmonary aspergillosis (IPA), which has high mortality (53-78%).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aims</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To establish the characteristics of IPA infection in HT recipients and their outcomes in our setting.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Of 328 heart transplantations performed in our center between 1998 and 2016, five cases of IPA were identified. Patient medical records were examined and clinical variables were extracted.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">All cases were male, with a mean age of 62 years. The most common indication for HT was nonischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The imaging assessment was based on chest radiography and chest computed tomography. The most commonly reported radiological abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and A. fumigatus was isolated in four cases on BAL culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three patients, 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 occurred in three patients. All patients survived after a mean follow-up of 18 months.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">IPA is a potentially lethal complication after HT. An early diagnosis and prompt initiation of aggressive treatment are the cornerstone for better survival.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introdução</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A infeção continua a ser a principal complicação dos doentes submetidos a transplante cardíaco (TC), originando aproximadamente 20% de mortalidade no primeiro ano pós transplante. Nesta população, a infeção Aspergillus pode causar diferentes quadros clínicos, incluindo a aspergilose pulmonar invasiva (API), com elevada mortalidade (53 a 78%).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estabelecer as características da infeção por API nos doentes de TC e apresentar os respetivos resultados do nosso centro.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">De 328 transplantes cardíacos realizados no nosso centro entre 1998 e 2016, identificámos cinco casos de API. Os registos médicos dos doentes foram examinados e as variáveis clínicas foram analisadas</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Todos os casos corresponderam a doentes do sexo masculino com a idade média de 62 anos. A indicação mais comum para TC foi a miocardiopatia dilatada não isquémica. A tosse produtiva foi registada como principal sintoma. A avaliação radiológica baseou-se na radiografia e na tomografia computorizada ao tórax. A alteração radiológica mais comum foi, em ambas as técnicas, o registo de densidades nodulares múltiplas. A broncoscopia foi realizada em todos os doentes e o aspergillus fumigatus foi isolado em quarto casos de cultura BAL. O tratamento incluiu anfotericina em quatro doentes com mudança subsequente para voriconazol em três doentes e posaconazol em um doente, duração média do tratamento total de 12 meses. A neutropenia foi observada apenas num doente, a insuficiência renal em dois doentes e a infeção por CMV concomitante ocorreu em três doentes. Todos os doentes sobreviveram após um seguimento médio até 18 meses.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusões</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A API representa uma complicação potencialmente letal após TC. O diagnóstico precoce e a instituição também precoce de tratamento agressivo constituem a pedra angular para uma melhor sobrevivência.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusões" ] ] ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 614 "Ancho" => 1250 "Tamanyo" => 106246 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing multiple nodular opacities and an incipient halo sign secondary to invasive pulmonary aspergillosis (yellow arrow).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">HT: heart transplantation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age, years \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indication \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Days since HT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Prednisone dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Immunosuppression \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Leukocytes/neutrophils \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Creatinine (mg/dl) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dilated cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyclosporine + mycophenolate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dilated cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tacrolimus + mycophenolate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chagas cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">116 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tacrolimus + azathioprine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Valvular cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">189 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tacrolimus + mycophenolate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9/1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ischemic cardiomyopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tacrolimus + mycophenolate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.2/10.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2530817.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics and laboratory features of the study population.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BAL: bronchoalveolar lavage; CMV: cytomegalovirus; CT: computed tomography; PCR: polymerase chain reaction.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Initial serum galactomannan level \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Concurrent CMV infection \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Confirmation test \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fungal prophylaxis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Chest radiography \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CT scan \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rejection \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL culture: <span class="elsevierStyleItalic">A. fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Micafungin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple micronodular opacities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amphotericin B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Productive cough \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL culture: <span class="elsevierStyleItalic">A. fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple nodular opacities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple nodular opacities and a 45-mm mass with peripheral halo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voriconazole + caspofungin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Productive cough and fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PCR (<span class="elsevierStyleItalic">A. fumigatus</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple nodular opacities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple nodular opacities (<10 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amphotericin + caspofungin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1B \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asymptomatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL culture: <span class="elsevierStyleItalic">A. fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral nodular opacities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multiple nodular opacities (<10 mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Voriconazole + anidulafungin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chest pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BAL culture: <span class="elsevierStyleItalic">A. fumigatus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fluconazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral nodular opacities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ground-glass pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amphotericin B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1A \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2530816.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical course and treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Life-threatening infection in transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.T. O'Shea" 1 => "A. Humar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccc.2013.06.012" "Revista" => array:6 [ "tituloSerie" => "Crit Care Clin" "fecha" => "2013" "volumen" => "29" "paginaInicial" => "953" "paginaFinal" => "973" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24094386" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive aspergillosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.W. Denning" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/513943" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "781" "paginaFinal" => "803" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9564455" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive aspergillosis in the setting of cardiac transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.G. Montoya" 1 => "S.V. Chaparro" 2 => "D. Celis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/376527" "Revista" => array:7 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2003" "volumen" => "37" "numero" => "Suppl. 3" "paginaInicial" => "S281" "paginaFinal" => "S292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12975755" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Invasive pulmonary aspergillosis in heart transplant recipients: two radiologic patterns with a different prognosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Muñoz" 1 => "A. Vena" 2 => "I. Ceron" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2014.05.003" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2014" "volumen" => "33" "paginaInicial" => "1034" "paginaFinal" => "1040" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25012980" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aspergillus infection complicating cardiac transplantation. Report of five cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Gurwith" 1 => "E.B. Stinson" 2 => "J.S. Remington" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Arch Intern Med" "fecha" => "1971" "volumen" => "128" "paginaInicial" => "541" "paginaFinal" => "545" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4939230" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X13005896" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.J. Walsh" 1 => "E.J. Anaissie" 2 => "D.W. Denning" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/525258" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "327" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18177225" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clin Infect Dis" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group" "etal" => true "autores" => array:3 [ 0 => "B. De Pauw" 1 => "T.J. Walsh" 2 => "J.P. Donnelly" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "fecha" => "2008" "volumen" => "46" "paginaInicial" => "1813" "paginaFinal" => "1821" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M.R. Costanzo" 1 => "A. Dipchand" 2 => "R. Starling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.healun.2010.05.034" "Revista" => array:6 [ "tituloSerie" => "J Heart Lung Transplant" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "914" "paginaFinal" => "956" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20643330" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparing outcomes between antibody induction therapies in kidney transplantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Koyawala" 1 => "J.H. Silber" 2 => "P. Rosenbaum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1681/ASN.2016070768c" "Revista" => array:7 [ "tituloSerie" => "J Am Soc Nephrol" "fecha" => "2017" "volumen" => "28" "paginaInicial" => "2188" "paginaFinal" => "2200" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28320767" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X15016394" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000004000000001/v1_202102241115/S2174204921000106/v1_202102241115/en/main.assets" "Apartado" => array:4 [ "identificador" => "80064" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communication" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000004000000001/v1_202102241115/S2174204921000106/v1_202102241115/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921000106?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 6 | 14 |
| 2024 October | 58 | 37 | 95 |
| 2024 September | 53 | 27 | 80 |
| 2024 August | 48 | 29 | 77 |
| 2024 July | 33 | 37 | 70 |
| 2024 June | 32 | 32 | 64 |
| 2024 May | 37 | 24 | 61 |
| 2024 April | 29 | 28 | 57 |
| 2024 March | 28 | 25 | 53 |
| 2024 February | 43 | 29 | 72 |
| 2024 January | 30 | 24 | 54 |
| 2023 December | 25 | 28 | 53 |
| 2023 November | 46 | 40 | 86 |
| 2023 October | 32 | 17 | 49 |
| 2023 September | 27 | 23 | 50 |
| 2023 August | 28 | 21 | 49 |
| 2023 July | 25 | 10 | 35 |
| 2023 June | 27 | 9 | 36 |
| 2023 May | 40 | 31 | 71 |
| 2023 April | 30 | 12 | 42 |
| 2023 March | 59 | 25 | 84 |
| 2023 February | 36 | 21 | 57 |
| 2023 January | 32 | 25 | 57 |
| 2022 December | 50 | 27 | 77 |
| 2022 November | 45 | 37 | 82 |
| 2022 October | 46 | 32 | 78 |
| 2022 September | 73 | 34 | 107 |
| 2022 August | 55 | 28 | 83 |
| 2022 July | 40 | 36 | 76 |
| 2022 June | 32 | 40 | 72 |
| 2022 May | 35 | 23 | 58 |
| 2022 April | 47 | 42 | 89 |
| 2022 March | 37 | 48 | 85 |
| 2022 February | 42 | 43 | 85 |
| 2022 January | 83 | 30 | 113 |
| 2021 December | 37 | 34 | 71 |
| 2021 November | 36 | 39 | 75 |
| 2021 October | 54 | 57 | 111 |
| 2021 September | 22 | 20 | 42 |
| 2021 August | 20 | 32 | 52 |
| 2021 July | 21 | 17 | 38 |
| 2021 June | 16 | 25 | 41 |
| 2021 May | 34 | 41 | 75 |
| 2021 April | 72 | 50 | 122 |
| 2021 March | 60 | 47 | 107 |
| 2021 February | 23 | 9 | 32 |
Show all
