Transplantation infection
Aspergillus infections after lung transplantation: clinical differences in type of transplant and implications for management

Presented in part at the American Transplant Congress, Washington, DC, April 27 to May 1, 2002.
https://doi.org/10.1016/S1053-2498(02)00477-1Get rights and content

Abstract

Background:

Invasive aspergillosis is a serious opportunistic infection in lung transplant recipients. It has not been fully discerned whether there are differences in the characteristics, risk factors and outcome of Aspergillus infection in single as compared with bilateral lung transplant recipients.

Methods:

English-language articles identified by a Medline search through December 2000 and bibliographies were used as data sources to identify cases of Aspergillus infections in lung transplant recipients. The studies selected had to have provided a definition of invasive aspergillosis to distinguish colonization from infection.

Results:

The median incidence of Aspergillus infections in lung transplant recipients was 6.2%. In total, 58% (45 of 78) of the Aspergillus infections were tracheobronchitis or bronchial anastomotic infections, 32% (25 of 78) were invasive pulmonary, and 22% (25 of 78) were disseminated infections. Single lung transplant recipients with Aspergillus infections were significantly older (p = 0.006), more likely to have had chronic obstructive pulmonary disease as an underlying illness (p = 0.05), more likely to have developed Aspergillus infections later after transplantation (p = 0.019), and tended to have a higher incidence of invasive aspergillosis (p = 0.11) than all other lung transplant recipients. Overall mortality in lung transplant recipients with Aspergillus infections was 52%. Single lung transplant recipients (p = 0.03), and patients with late-onset infections (occurring at least 3 months after transplantation ([p = 0.045]) infections had significantly higher mortality.

Conclusions:

Single lung transplant recipients with Aspergillus infections had an overall greater morbidity and poorer outcome than other types of lung transplant recipients. Recognition of the unique characteristics of Aspergillus infections in single lung (vs bilateral or heart–lung) transplant recipients has implications relevant for the management of lung transplant recipients with aspergillosis.

Section snippets

Methods

Cases of Aspergillus infections in lung transplant recipients were identified by a Medline search through December 2000. Search terms included “aspergillosis,” “fungal infections” and “lung transplant.” Additional cases were identified by review of the bibliographies of the search articles. The studies included had to provide a definition of invasive aspergillosis to distinguish colonization from infection. Reports were limited to those published in or translated into English. Cases reported in

Epidemiology and demographic characteristics

A total of 159 cases of Aspergillus infections were identified in 40 published reports.1, 2, 3, 4, 5, 6, 7, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 Of these, 87 were individually detailed cases, and 72 were summarized in reports containing 2 to 14 cases. The type of lung transplantation was reported in 66 patients. Overall, 51.5% (34 of 66) of the patients with Aspergillus infections were single lung

Discussion

Although previous reports have alluded to a higher incidence of Aspergillus infections in single lung transplant recipients,37, 42 our study has documented the unique characteristics and an overall greater impact of Aspergillus infections after single lung transplantation. Single lung transplant recipients were significantly older, more likely to have chronic obstructive pulmonary disease as an indication for lung transplantation or have developed Aspergillus infections later after

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