Fungal Infections After Lung Transplantation

Kennedy, Cassie C.; Razonable, Raymund R.

doi:10.1016/j.ccm.2017.04.011

Cited by 45 publications

(66 citation statements)

References 37 publications

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“…Careful balance in immunosuppression is needed to successfully manage patients after LT to prevent and treat both the rejection of the lung allograft and bacterial, viral, and fungal infections. Although less frequent than bacterial and viral infections, invasive fungal infection is associated with higher morbidity and mortality after LT [ 15 ]. The depth of immunosuppression is associated with both increased incidence and worse outcome of invasive fungal infections [ 5 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Disseminated Scedosporium apiospermum central nervous system infection after lung transplantation: A case report with successful recovery

Paajanen

Halme

Palomäki

et al. 2019

Medical Mycology Case Reports

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Scedosporium species are fungal opportunistic pathogens frequently seen in chronic lung diseases such as in cystic fibrosis (CF). They can cause a wide spectrum of diseases mainly in immunodeficient patients. Invasive, disseminated infections with poor prognosis have been described after lung transplantation. We present a CF-patient with disseminated Scedosporium apiospermum infection after lung transplantation. The patient had skin, surgical wound, spinal cord, and brain involvements. She recovered fully after prolonged course of voriconazole treatment.

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Section: Discussionmentioning

confidence: 99%

“…There is no widely accepted optimal recommendation for antifungal prophylaxis after LT [ 15 ]. The standard regimen used in our institute is trimethoprim/sulfamethoxazole for Pneumocystis jirovecii .…”

Section: Discussionmentioning

confidence: 99%

Disseminated Scedosporium apiospermum central nervous system infection after lung transplantation: A case report with successful recovery

Paajanen

Halme

Palomäki

et al. 2019

Medical Mycology Case Reports

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“…A broad range of risk factors for pulmonary fungal infections after lung transplantation have been proposed (reviewed in [ 79 ]). Factors related to the lung allograft, like environmental exposure and infection of the lung allograft [ 80 ], increased donor age [ 81 ], anatomic abnormalities, and physiologic characteristics of the transplanted lung such as impaired mucociliary clearance, blunted cough reflex, denervation injury, and bronchial anastomotic complications [ 82 ] could predispose to a higher risk of invasive fungal infections.…”

Section: Pulmonary Fungal Infections In Lung Transplant Recipientsmentioning

confidence: 99%

“…Prophylaxis strategies are heterogeneous and mostly center-specific though, the duration of prophylaxis ranges from six to 12 months post-transplant, some centers recommend universal strategies, independent of colonization status and diagnosis, others use targeted or empiric prophylaxis and pre-emptive treatment whenever fungi are detected in airway samples. Single-agent prophylaxis is used as well as combinations of inhaled liposomal amphotericin B and oral triazoles [ 79 ]. A recent published survey across 44 United States adult lung transplant centers revealed that 97.5% of centers used post-transplant prophylaxis, 90% of centers advocating universal prophylaxis with nebulized amphotericin in combination with triazole agents for six months or less, and four centers also used pretransplant prophylaxis.…”

Section: Post-transplant Antifungal Prophylaxismentioning

confidence: 99%

Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation

Renner

Nachbaur

Jaksch

et al. 2020

JoF

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Cystic fibrosis is the most common autosomal-recessive metabolic disease in the Western world. Impaired trans-membrane chloride transport via the cystic fibrosis transmembrane conductance regulator (CFTR) protein causes thickened body fluids. In the respiratory system, this leads to chronic suppurative cough and recurrent pulmonary infective exacerbations, resulting in progressive lung damage and respiratory failure. Whilst the impact of bacterial infections on CF lung disease has long been recognized, our understanding of pulmonary mycosis is less clear. The range and detection rates of fungal taxa isolated from CF airway samples are expanding, however, in the absence of consensus criteria and univocal treatment protocols for most respiratory fungal conditions, interpretation of laboratory reports and the decision to treat remain challenging. In this review, we give an overview on fungal airway infections in CF and CF-lung transplant recipients and focus on the most common fungal taxa detected in CF, Aspergillus fumigatus, Candida spp., Scedosporium apiospermum complex, Lomentospora species, and Exophiala dermatitidis, their clinical presentations, common treatments and prophylactic strategies, and clinical challenges from a physician’s point of view.

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“…The spores of Aspergillus are ubiquitous in and out of the hospital. The most common Aspergillus infection in the lung transplant recipients is tracheobronchitis [ 61 ].…”

Section: Post-transplant Monitoringmentioning

confidence: 99%

Lung Transplantation in Idiopathic Pulmonary Fibrosis

et al. 2018

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Despite the advances in recent years in the treatment of idiopathic pulmonary fibrosis (IPF), it continues to be a progressive disease with poor prognosis. In selected patients, lung transplantation may be a treatment option, with optimal results in survival and quality of life. Currently, pulmonary fibrosis is the main cause of lung transplantation. However, mortality on the waiting list of these patients is high, since many patients are referred to the transplant units with advanced disease. There is not a parameter that can predict the survival of a specific patient. Different variables are to be considered in order to decide the right time to send them to a transplant unit. It is also very difficult to decide when to include these patients on the waiting list. Every patient diagnosed with IPF, without contraindications for surgery, should be referred early to a transplant unit for assessment. A uni or bilateral transplantation will be decided based on the characteristics of the patient and the experience of each center. The post-transplant survival of recipients with IPF is lower than that observed in other diseases, such as cystic fibrosis or chronic obstructive pulmonary disease as a consequence of their older age and the frequent presence of associated comorbidity. Post-transplant follow-up must be tight in order to assure optimal level of immunosuppressive treatment, detect complications associated with it, and avoid graft rejection. The main cause of long-term mortality is late graft dysfunction as a consequence of chronic rejection. Other complications, such as infections and tumors, must be considered.

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Fungal Infections After Lung Transplantation

Cited by 45 publications

References 37 publications

Disseminated Scedosporium apiospermum central nervous system infection after lung transplantation: A case report with successful recovery

Disseminated Scedosporium apiospermum central nervous system infection after lung transplantation: A case report with successful recovery

Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation

Lung Transplantation in Idiopathic Pulmonary Fibrosis

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