Fungal Prophylaxis and Chronic Lung Allograft Dysfunction

Beach, Shire; Schaenman, Joanna; Shino, Yusaku; Ramsey, Anthony R.; Saggar, Rajeev; Sayah, David M.; Derhovanessian, Ariss; Lynch, Joseph P.; Ardehali, A.; Belperio, John A.; Weigt, S. Samuel

doi:10.1016/j.healun.2020.01.679

Cited by 2 publications

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“…11 Additionally, efforts to prevent fungal colonization with antifungal medications have not resulted in improved CLAD-free survival. 12 Likewise, efforts to eradicate fungal airway colonization have been met…”

Section: Introductionmentioning

confidence: 99%

“…conidia are associated with the development of CLAD 10 or have found no association between fungal colonization and the development of CLAD 11 . Additionally, efforts to prevent fungal colonization with antifungal medications have not resulted in improved CLAD‐free survival 12 . Likewise, efforts to eradicate fungal airway colonization have been met with mixed results 13,14 …”

Section: Introductionmentioning

confidence: 99%

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Fungal infection and colonization in lung transplant recipients with chronic lung allograft dysfunction

Pennington

Aversa

Martinu

et al. 2022

Transplant Infectious Dis

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Background The incidence and impact of de novo fungal airway colonization and infection in lung transplant recipients (LTRs) with known chronic lung allograft dysfunction (CLAD) has not been established. We aimed to determine the 1‐year cumulative incidence and risk factors of de novo fungal colonization or infection in LTRs with CLAD and assess the impact of colonization or infection on post‐CLAD survival. Methods Prospectively collected Toronto Lung Transplant Program database and chart review were used for double‐LTRs who were diagnosed with CLAD from January 1, 2016 to January 1, 2020 and who were free of airway fungi within 1 year prior to CLAD onset. International Society for Heart and Lung Transplantation definitions were used to define clinical syndromes. Cox‐Proportional Hazards Models were used for risk‐factor analysis. Survival analysis could not be completed secondary to low number of fungal events; therefore, descriptive statistics were employed for survival outcomes. Results We found 186 LTRs diagnosed with CLAD meeting our inclusion criteria. The 1‐year cumulative incidence for any fungal event was 11.8% (7.0% for infection and 4.8% for colonization). Aspergillus fumigatus was a causative pathogen in eight of 13 (61.5%) patients with infection and six of nine (66.7%) patients with colonization. No patients with fungal colonization post‐CLAD developed fungal infection. Peri‐CLAD diagnosis (3 months prior or 1 month after) methylprednisolone bolus (hazards ratio: 8.84, p = .001) increased the risk of fungal events. Most patients diagnosed with fungal infections (53.8%) died within 1‐year of CLAD onset. Conclusion De novo IFIs and fungal colonization following CLAD onset were not common. Fungal colonization did not lead to fungal infection. Methylprednisolone bolus was a significant risk factors for post‐CLAD fungal events.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fungal infection and colonization in lung transplant recipients with chronic lung allograft dysfunction

Pennington

Aversa

Martinu

et al. 2022

Transplant Infectious Dis

View full text Add to dashboard Cite

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Chronic Lung Allograft Dysfunction: Clinical Manifestations and Immunologic Mechanisms

Bery,

Belousova,

Hachem

et al. 2024

Transplantation

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The term “chronic lung allograft dysfunction” has emerged to describe the clinical syndrome of progressive, largely irreversible dysfunction of pulmonary allografts. This umbrella term comprises 2 major clinical phenotypes: bronchiolitis obliterans syndrome and restrictive allograft syndrome. Here, we discuss the clinical manifestations, diagnostic challenges, and potential therapeutic avenues to address this major barrier to improved long-term outcomes. In addition, we review the immunologic mechanisms thought to propagate each phenotype of chronic lung allograft dysfunction, discuss the various models used to study this process, describe potential therapeutic targets, and identify key unknowns that must be evaluated by future research strategies.

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Fungal Prophylaxis and Chronic Lung Allograft Dysfunction

Cited by 2 publications

References 0 publications

Fungal infection and colonization in lung transplant recipients with chronic lung allograft dysfunction

Fungal infection and colonization in lung transplant recipients with chronic lung allograft dysfunction

Chronic Lung Allograft Dysfunction: Clinical Manifestations and Immunologic Mechanisms

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