Aspergillus and endobronchial abnormalities in lung transplant recipients.
OBJECTIVE
To determine the relationship between aspergillus recovery from the airways of lung transplant recipients and the development of endobronchial abnormalities.


METHODS
Retrospective case series.


METHODS
Tertiary-care hospital.


METHODS
All patients who underwent lung transplantation between December 1991 and June 1999.


RESULTS
The study cohort included 38 patients. The primary end point was the bronchoscopic identification of an endobronchial abnormality. Aspergillus was isolated from the lungs of nine patients (23.7%). Most of these isolates occurred early after transplantation (mean, 8 weeks). Endobronchial abnormalities arose in seven of the patients (18.4%) and manifested as either exuberant granulation tissue or stricture formation. Six of the 9 (66.6%) patients with aspergillus developed airway lesions, compared to 1 of the 29 patients (3.4%) without aspergillus (p = 0.0002). Endobronchial abnormalities were 19.3 times more likely to occur in patients in whom aspergillus had previously been isolated. As a screening test for the subsequent diagnosis of an airway complication, the recovery of aspergillus had a sensitivity and specificity of 85.7% and 90.3%, respectively. These aspergillus-related endobronchial abnormalities were clinically relevant as evidenced by a mean increase of 25.9% in the FEV(1) after bronchoscopic intervention.


CONCLUSIONS
The early isolation of aspergillus from the airways of lung transplant recipients identifies patients at increased risk for the development of clinically significant endobronchial abnormalities.
Inova Transplant Center, Inova Fairfax Hospital, Falls Church, VA 22042-3300, USA. steven.nathan@inova.com
S D
SD
Nathan
A F
AF
Shorr
M E
ME
Schmidt
N A
NA
Burton
D001228:Aspergillosis / Q000382:microbiology* / Q000503:physiopathology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D001982:Bronchial Diseases / Q000382:microbiology* / Q000503:physiopathology; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008172:Lung Diseases, Fungal / Q000382:microbiology* / Q000503:physiopathology; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000503:physiopathology