Chest
Volume 112, Issue 5, November 1997, Pages 1160-1164
Journal home page for Chest

Clinical Investigations: Lung Transplantation
Aspergillus Airway Colonization and Invasive Disease After Lung Transplantation

https://doi.org/10.1378/chest.112.5.1160Get rights and content

Background

Invasive Aspergillus is an important cause of morbidity and mortality among lung transplant recipients. The diagnosis can be difficult and treatment is often unsuccessful so many centers preemptively treat all Aspergillus airway isolates to prevent invasive disease. This approach is untested as little is known about the relationship between Aspergillus airway colonization and invasive disease. This study was undertaken to evaluate the incidence of Aspergillus airway colonization after lung transplantation and the risk of invasive disease after colonization.

Design

All cultures and histologic specimens obtained from a consecutive series of 151 lung transplant cases were reviewed for the presence of Aspergillus and compared with clinical data.

Results

Aspergillus was isolated from the airway in 69 (46%;) of 151 transplant recipients. Invasive disease occurred in five cases and was uniformly fatal, accounting for 13%; of all posttransplant deaths. Results of cytologic examination of BAL fluid were normal in all cases of invasive disease and cultures were positive in only one of five patients prior to invasion. Invasive disease occurred exclusively in patients who died or were colonized with Aspergillus fumigatus within the first 6 months posttransplant. Patients growing A fumigatus from the airway during the first 6 months were 11 times more likely to develop invasive disease relative to those not colonized.

Conclusion

Aspergillus airway colonization after lung transplantation is common and in most cases, transient. In contrast, invasive Aspergillus disease is less common, but fatal. Bronchoscopy with cytologic examination and fungal culture are not sensitive or timely predictors of invasive disease. Invasive Aspergillus occurred only in patients initially colonized with A fumigatus within the first 6 months posttransplant. A trial of empiric anti-Aspergillus therapy limited to the first 6 months posttransplant may be warranted.

Section snippets

MATERIALS AND METHODS

Between May 1986 and October 1994, we evaluated a consecutive series of 147 patients undergoing lung or heart-lung transplantation at the University of Minnesota. A transplantation case was defined as a new transplant or a retransplant that was performed at least 6 months after the original surgery when immunosuppression had been tapered to its lowest level.

After transplantation, all patients were maintained on a regimen of immunosuppression with cyclosporine, azathioprine, and prednisone (0.5

RESULTS

Between May 1986 and October 1994, 147 patients (62 men and 85 women) with advanced pulmonary or pulmonary vascular disease underwent 153 lung or heart-lung transplantation procedures at the University of Minnesota. The median patient age at the time of transplantation was 44 years (range, 3 to 64 years). Six of the 153 transplants were retransplant surgeries for acute or chronic graft failure. Four of the retransplants were performed more than 6 months after the original surgery and were thus

DISCUSSION

Invasive fungal infection caused by Aspergillus is an often fatal complication of lung transplantation.2,3,6,13 The lung is the presumed portal of entry for fungal spores, and direct invasion of the lung or airway is present in the vast majority of transplant recipients dying with invasive Aspergillosis.9,14, 15, 16 This was confirmed in our study where invasive disease had a 100%; mortality rate and four of the five patients with invasive disease had fungal invasion of the transplanted lung.

REFERENCES (20)

  • B.D. Fisher et al.

    Invasive aspergillosis: progress in early diagnosis and treatment

    Am J Med

    (1981)
  • R.D. Meyer et al.

    Aspergillosis complicating neoplastic disease

    Am J Med

    (1973)
  • J.S. Dummer et al.

    Infections in heart-lung transplant recipients

    Transplantation

    (1986)
  • M.R. Kramer et al.

    Infectious complications in heart-lung transplantation: analysis of 200 episodes

    Arch Intern Med

    (1993)
  • J.R. Mauer et al.

    Infectious complications following isolated lung transplantation

    Chest

    (1992)
  • G.E. Westney et al.

    Aspergillus infection in single and double lung transplant recipients

    Transplantation

    (1996)
  • V. Yelandi et al.

    Aspergillus and lung transplantation

    J Heart Lung Transplant

    (1995)
  • I.L. Paradis et al.

    Infection after lung transplantation

    Semin Respir Infect

    (1993)
  • G. Thommi et al.

    Spectrum of invasive pulmonary aspergillosis in immunocompetent patients with chronic obstructive pulmonary disease

    South Med J

    (1991)
  • L.B. Palmer et al.

    Corticosteroid treatment as a risk factor for invasive aspergillosis in patients with lung disease

    Thorax

    (1991)
There are more references available in the full text version of this article.

Cited by (205)

  • Fungal Infections After Lung Transplantation

    2017, Clinics in Chest Medicine
View all citing articles on Scopus
View full text