Spectrum of Aspergillus Infection in Lung Transplant Recipients: Case Series and Review of the Literature

doi:10.1378/chest.119.1.169

Chest

Volume 119, Issue 1, January 2001, Pages 169-175

https://doi.org/10.1378/chest.119.1.169 Get rights and content

Study objectives:

(1) To define the incidence andnatural history of Aspergillus colonization and infection in lungtransplant recipients, and (2) to assess the impact of prophylaxis, surveillance, and therapy on the incidence and outcome of thedisease.

Design:

Retrospective review of 133consecutive single or bilateral lung transplantations performed at asingle institution, and review of the published literature.

Results:

Airway colonization, isolated tracheobronchitis, and invasive pneumonia due to Aspergillus species occurred in 29%,5%, and 8% of our series, and in 26%, 4%, and 5% of the pooledpublished data (all series, including ours), respectively. Greater than50% of all diagnoses were made in the first 6 months aftertransplantation in both our series and the published literature. Incidence of progression from airway colonization to invasive diseasewas 1 in 38 in our series and 3 of 97 (3%) in the pooled publisheddata. In patients with isolated tracheobronchitis, all 6 patients inour series and 41 of 50 patients (82%) in all published series, including ours, responded to antifungal therapy and/or surgicaldebridement. Among patients with invasive pneumonia or disseminateddisease, however, 5 of 10 patients in our series and 26 of 64 patients(41%) in the pooled series survived their infection.

Conclusions:

The role of antifungal therapy in Aspergillusairway colonization in lung transplant recipients is unclear. Datasupport a strategy of scheduled screening bronchoscopy followed byaggressive treatment for isolated Aspergillus tracheobronchitis in lungtransplant recipients.

Section snippets

Patients

We reviewed the medical records of all patients who underwentlung transplantation at our institution between November 1990 and, August 1998, and collected evidence of Aspergillus infections. Allpatients received an immunosuppressive regimen consisting ofcorticosteroids (methylprednisolone, 200 mg/d postoperatively, switchedto oral prednisone, 0.5 mg/kg/d, tapered to 0.1 mg/kg/d over 6 months);azathioprine, 2 mg/kg/d; and cyclosporine A; as well as prophylacticganciclovir (in patients receiving

Incidence of Isolation of Aspergillus Species

Between November 1990 and August 1998, 130 patients (69 men)underwent 133 lung transplantations at our institution (111 single and22 bilateral lung transplantations). The median age at the time oftransplantation was 51 years (range, 18 to 63 years). Three patientsunderwent retransplantation for acute or chronic graft failure. Aspergillus species were isolated from 53 of our patients (40%; Table 1). The most common isolated species wasAspergillus fumigatus (58%), followed by Aspergillusniger

Discussion

Invasive aspergillosis is a potentially fatal complication ofimmunosuppression. While the disease has been studied in otherimmunocompromised hosts, its optimal management in lung transplantrecipients has not been systematically investigated. Given that thenumber of patients who develop invasive aspergillosis in any given lungtransplantation center is limited, randomized studies to evaluate theoptimal diagnostic or preventative approach are difficult to perform. We therefore summarized the

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Citation Excerpt :
One important clinical manifestation of invasive aspergillosis in patients with severe viral pneumonia is invasive Aspergillus tracheobronchitis (IATB), which is characterised by plaques in the large airways (ie, trachea and bronchi). Although a known manifestation of invasive aspergillosis in recipients of lung transplants,13 up to 56% of patients with IAPA have been reported to present with IATB.4,14 Epithelial erosion due to virus replication is most likely an important predisposing factor to developing IATB, as this factor can provide a portal of entry for Aspergillus to cause invasive airway disease.
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Fungus-positive respiratory samples (FPRS) are common in the intensive Care unit (ICU) and are usually considered to correspond to colonization. The management of FPRS during the early postoperative course after lung transplantation (LT) remains unclear. The epidemiology, clinical consequences, and prognosis of FPRS were assessed in LT recipients.
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A high prevalence of FPRS is reported after LT, mainly with Candida spp. The lack of association between post-LT FPRS and mortality and morbidity suggests avoiding antifungal therapy in the absence of clinical signs of invasive infection.
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View all citing articles on Scopus

: Supported in part by National Institutes of Health grants 1P50HL46487and 1K08HL04220–01.

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Clinical InvestigationsTRANSPLANTATIONSpectrum of Aspergillus Infection in Lung Transplant Recipients: Case Series and Review of the Literature

Study objectives:

Design:

Results:

Conclusions:

Section snippets

Patients

Incidence of Isolation of Aspergillus Species

Discussion

J Infect

Diagn Microbiol Infect Dis

Chest

Chest

Clin Chest Med

Chest

Chest

Chest

Chest

Chest

Am J Ophthalmol

J Thorac Cardiovasc Surg

Chest

Chest

Transplant Proc

Chest

Aspergillosis and other systemic mycoses: the growing problem

JAMA

Strategies in prevention of invasive pulmonary aspergillosis in immunosuppressed or neutropenic patients

Antimicrob Agents Chemother

Aspergillosis in immunocompromised paediatric patients: associations with building hygiene, design, and indoor air

Thorax

Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures

J Infect Dis

Therapeutic outcome in invasive aspergillosis

Clin Infect Dis

Invasive aspergillosis in transplant recipients

Medicine (Baltimore)

Fungal infections in lung transplant recipients

Transplant Proc

Infectious complications of lung transplantation: impact of cystic fibrosis

Am J Respir Crit Care Med

Invasive aspergillosis after transplantation

Transplant Proc

Clinical Investigations
TRANSPLANTATION
Spectrum of Aspergillus Infection in Lung Transplant Recipients: Case Series and Review of the Literature