Risk factors of invasive fungal infections in lung transplant recipients: A systematic review and meta-analysis

Phoompoung, Pakpoom; Villalobos, Armelle Pérez Cortés; Jain, Shilpa R.; Foroutan, Farid; Orchanian‐Cheff, Ani; Husain, Shahid

doi:10.1016/j.healun.2021.09.014

Cited by 21 publications

(23 citation statements)

References 37 publications

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“…The risk of IA was significantly higher in patients who previously had had CMV. This has been demonstrated before in both mixed SOTr cohorts (15, 33) and in LTXr exclusively (16, 34–37). Our risk estimate was lower than in some earlier reports, which was related to the adjustment of time after transplantation in our analysis.…”

Section: Discussionsupporting

confidence: 79%

Associations between invasive aspergillosis and cytomegalovirus in lung transplant recipients: a nationwide cohort study

Wulff

Perch

Helweg‐Larsen

et al. 2023

APMIS

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Cytomegalovirus (CMV) and invasive aspergillosis (IA) cause morbidity among lung transplant recipients (LTXr). Early diagnosis and treatment could improve outcomes. We examined rates of CMV after IA and vice versa to assess whether screening for one infection is warranted after detecting the other. All Danish LTXr, 2010–2019, were followed for IA and CMV for 2 years after transplantation. IA was defined using ISHLT criteria. Adjusted incidence rate ratios (aIRR) were estimated by Poisson regression adjusted for time after transplantation. We included 295 LTXr, among whom CMV and IA were diagnosed in 128 (43%) and 48 (16%). The risk of CMV was high the first 3 months after IA, IR 98/100 person‐years of follow‐up (95% CI 47–206). The risk of IA was significantly increased in the first 3 months after CMV, aIRR 2.91 (95% CI 1.32–6.44). Numbers needed to screen to diagnose one case of CMV after IA, and one case of IA after CMV was approximately seven and eight, respectively. Systematic screening for CMV following diagnosis of IA, and vice versa, may improve timeliness of diagnosis and outcomes for LTXr.

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Section: Discussionsupporting

confidence: 79%

Associations between invasive aspergillosis and cytomegalovirus in lung transplant recipients: a nationwide cohort study

Wulff

Perch

Helweg‐Larsen

et al. 2023

APMIS

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“…The nature and severity of the underlying end-organ dysfunction modulate risk. Cystic fibrosis and prior respiratory colonization with pathogenic moulds increase risk of postlung transplant invasive mould infection (IMI) [23 ▪ ]. Diabetic nephropathy is a risk factor for IA in renal transplant recipients [24], and in liver transplantation, iron-overload in the explant increases risk of IFI [25].…”

Section: The Hostmentioning

confidence: 99%

Diagnosis of invasive respiratory mycoses in the immunocompromised host

Houston

Wilson

Stone

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewThe burden of invasive fungal infection is increasing worldwide, largely due to a growing population at-risk. Most serious human fungal pathogens enter the host via the respiratory tract. Early identification and treatment of invasive fungal respiratory infections (IFRIs) in the immunocompromised host saves lives. However, their accurate diagnosis is a difficult challenge for clinicians and mortality remains high.Recent findingsThis article reviews IFRIs, focussing on host susceptibility factors, clinical presentation, and mycological diagnosis. Several new diagnostic tools are coming of age including molecular diagnostics and point-of-care antigen tests. As diagnosis of IFRI relies heavily on invasive procedures like bronchoalveolar lavage and lung biopsy, several novel noninvasive diagnostic techniques are in development, such as metagenomics, ‘volatilomics’ and advanced imaging technologies.SummaryWhere IFRI cannot be proven, clinicians must employ a ‘weights-of-evidence’ approach to evaluate host factors, clinical and mycological data. Implementation studies are needed to understand how new diagnostic tools can be best applied within clinical pathways. Differentiating invasive infection from colonization and identifying antifungal resistance remain key challenges. As our diagnostic arsenal expands, centralized clinical mycology laboratories and efforts to ensure access to new diagnostics in low-resource settings will become increasingly important.

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“…In the early post lung transplantation period, factors such as previous mould colonization and bronchial ischaemia are crucial to develop invasive anastomosis infections or tracheobronchial forms. Increased immunosuppression due to CLAD, structural alterations of the native lung or rejected graft, viral infections, immunodeficiency and renal failure are key to the development of these mould infections [30,35 ▪▪ ].…”

Section: Mould Infections: Aspergillus Scedosporium Spp and Lomentosp...mentioning

confidence: 99%

Multiresistant organisms: bacteria and beyond

Solé¹

2022

Current Opinion in Organ Transplantation

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Purpose of reviewInfections with multiresistant organisms are an emerging problem, cause early mortality post lung transplantation and are sometimes associated with graft dysfunction. Frequently they raise questions about the selection of lung transplant candidates and therapeutic management post lung transplantation. There are no guidelines and management must be individualized. This review summarizes the available therapeutic options in cases of multidrug-resistant (MDR) organisms and outcomes after lung transplant.Recent findingsImprovements in diagnosis, new and more effective drugs and the experience gained in the management of these infections in lung transplantation, lead to a more optimistic horizon than that found a decade ago.SummaryUpdate on the management of Burkholderia cepacia complex, Mycobacterium abscessus complex, Aspergillus spp., Scedosporium spp. and Lomentospora prolificans infections. This review clarifies current posttransplant outcomes and adds a little hope in these scenarios.

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Risk factors of invasive fungal infections in lung transplant recipients: A systematic review and meta-analysis

Cited by 21 publications

References 37 publications

Associations between invasive aspergillosis and cytomegalovirus in lung transplant recipients: a nationwide cohort study

Associations between invasive aspergillosis and cytomegalovirus in lung transplant recipients: a nationwide cohort study

Diagnosis of invasive respiratory mycoses in the immunocompromised host

Multiresistant organisms: bacteria and beyond

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