Aspergillus infection in lung transplant patients: incidence and prognosis

Abstract

Lung transplant recipients experience a particularly high incidence of Aspergillus infection in comparison with other solid-organ transplantations. This study was conducted to determine the incidence of Aspergillus colonisation and invasive aspergillosis, and the impact on long-term survival associated with Aspergillus infection. A retrospective study of 362 consecutive lung transplant patients from a single national centre who were transplanted 1992-2003 were studied. Twenty-seven patients were excluded due to incomplete or missing files. A total of 105/335 (31%) patients had evidence of Aspergillus infection (colonisation or invasion), including 83 (25%) patients with colonisation and 22 (6%) patients with radiographic or histological evidence of invasive disease. Most of the infections occurred within the first 3 months after transplantation. Cystic fibrosis (CF) patients had higher incidences of colonisation and invasive disease [15 (42%) and 4 (11%) of 36 patients] than non-CF patients [68 (23%) and 18 (6%) of 299 patients] (P = 0.01). Invasive aspergillosis was associated with 58% mortality after 2 years, whereas colonisation was not associated with early increased mortality but was associated with increased mortality after 5 years compared to non-infected patients (P < 0.05). An analysis of demographic factors showed that donor age [OR 1.40 per decade (95% CI 1.10-1.80)], ischaemia time [OR 1.17 per hour increase (95% CI 1.01-1.39)], and use of daclizumab versus polyclonal induction [OR 2.05 (95% CI 1.14-3.75)] were independent risk factors for Aspergillus infection. Invasive aspergillosis was associated with early and high mortality in lung transplant patients. Colonisation with Aspergillus was also associated with a significant increase in mortality after 5 years. CF patients have a higher incidence of Aspergillus infection than non-CF patients.

High Prevalence of Azole-Resistant Aspergillus fumigatus in Adults with Cystic Fibrosis Exposed to Itraconazole

“…For example, the in vitro resistance of A. fumigatus to oral azole therapies had been associated with treatment failure in subjects with aspergillosis (15). These findings may be particularly relevant for subjects with severe CF in whom lung transplantation is associated with a higher risk of invasive aspergillosis (16).…”

Prevention of invasive fungal infections in lung transplant patients

“…In addition to suppressed humoral and cell-mediated immunity (particularly with daclizumab induction therapy [11]), narrowing of the airway at the bronchial anastomosis may be present. Patients are also now routinely exposed to many fungal pathogens including Cryptococcus, Pneumocystis jiroveci, and molds such as Aspergillus, further predisposing to invasive disease.…”

Fungal Infections in Transplant and Oncology Patients

“…For example, prolonged operative time requiring multiple blood transfusions, reperfusion organ injury during transplantation, and/or multiple simultaneous organ transplants have all been associated with the development of fungal infections [85]. One study associated prolonged ischemia time with the development of IA in lung transplant recipients [86]. Liver transplant recipients have been shown to be at higher risk for IFIs if there is fulminant hepatic failure, a need to undergo retransplantation, or renal failure.…”