Chest
Clinical InvestigationsSaprophytic Fungal Infections and Complications Involving the Bronchial Anastomosis Following Human Lung Transplantation
Section snippets
Materials and Methods
The investigation involved a retrospective review of all LTX procedures performed between June 1993 and December 2000. To allow for an interval of adequate post-transplantation surveillance, a recipient had to survive a minimum of 75 days following transplantation to be included in the study. No recipient having an infection or complication of the BA died before postoperative day 75.
As previously described, in patients undergoing single-LTX, implantation of the donor organ was achieved by
Results
During the study period, 66 transplant procedures were performed in 65 recipients. One recipient received a second single-LTX after the initial allograft was compromised by the development of obliterative bronchiolitis. Of these 65 recipients, 17 were recipients of double-LTXs and 48 were recipients of single-LTXs. Sixty-one of these recipients survived a minimum of 75 days following the transplant procedure, and these recipients comprised the study group. Of these 61 recipients, 38 were men
Discussion
The bronchial circulation, being the primary source of blood flow to the major bronchi, is disrupted during the single-LTX and double-LTX procedures. Consequently, in the early post-transplantation period the BA site is initially devascularized, which may result in the sloughing of epithelial tissue into the airway lumen. Saprophytic fungal organisms are easily airborne and thus have ready access to the airway lumen and the relatively ischemic BA. As saprophytes are organisms that obtain their
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Cited by (104)
Risk factors and prognosis of airway complications in lung transplant recipients: A systematic review and meta-analysis
2023, Journal of Heart and Lung TransplantationISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics
2018, Journal of Heart and Lung TransplantationTransplantation-Related Lung Pathology
2018, Pulmonary Pathology: A Volume in the Series: Foundations in Diagnostic PathologyFungal Infections After Lung Transplantation
2017, Clinics in Chest MedicineCitation Excerpt :In another series, 9.8% of recipients had Candida spp and 16.4% had Aspergillus anastomotic infections (including 1 recipient with both organisms).36 The airway complication rate after fungal infection in this series was 46.7%, including bronchial stenosis and hemorrhage; the mortality rate was 20%.36 Rare cases of Zygomycetes-associated anastomotic infections have been reported.37
Therapeutic approach to respiratory infections in lung transplantation
2015, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Endoscopic appearance resembles an ulcerative tracheobronchitis with necrosis and pseudomembrane formation with airway stenosis and suture line dehiscence [29,30]. This may lead to subsequent invasion of the neighbouring pulmonary artery causing severe haemoptysis and is understandably associated with high mortality [31]. Most cases of invasive aspergillosis (IA) occur within the first year after transplantation, affecting approximately 5% of LTRs involving lung parenchyma with or without extrapulmonary involvement [32].
Supported in part by the McKelvey Fund of the Tides Foundation.