Fungal infections in lung transplantation. Incidence, risk factors and prognostic significance.
OBJECTIVE
Fungal infections are frequent following lung transplantation and are associated with high mortality and morbidity. The study aims at 1) reporting our experience with fungal infections after lung transplantation; 2) identifying statistically significant correlations between the occurrence of fungal infections and bacterial infections, cytomegalovirus disease, rejection and steroid therapy; 3) assessing whether the presence of fungal infection has an impact on long-term survival.


METHODS
60 lung transplant recipients were studied with respect to incidence, pattern of presentation and median time to presentation of fungal infection after the transplant. Correlation analysis of the variables of interest was undertaken in 30 patients who had a minimum follow-up of 1 year following transplant.


RESULTS
The prevalence of fungal infection was 44%; severe infections occurred in 5 patients (11%). The presence of Candida preoperatively was not associated with an increased risk of fungal infection. In a logistic regression analysis, a significant correlation was found between the occurrence of fungal infection and the following variables: respiratory bacterial infections (p = 0.0003), cytomegalovirus disease (p = 0.00001) and steroid therapy (p = 0.04). No statistically significant difference was found between patients who experienced a fungal infection and those who did not, either in univariate or multivariate survival analysis (p = 0.08).


CONCLUSIONS
1) fungal infections are frequent in lung transplant recipients and may be severe in more than 10% of the cases; 2) the presence of fungi preoperatively is not a contraindication to transplantation: an antifungal prophylaxis is probably indicated in such cases postoperatively; we recommend the use of the less nephrotoxic liposomal Amphotericin B by aerosol route; 3) a statistically significant association exists between fungal infections and both steroid therapy and CMV disease; this suggests that a similar antifungal prophylaxis is indicated in these clinical circumstances; 4) the presence of fungal infection is not an independent prognostic factor of long-term survival.
Ruffini
E
E
Department of Thoracic Surgery, University of Torino, 3, Via Genova, 10126 Torino, Italy. enrico.ruffini@unito.it
Baldi
S
S
Rapellino
M
M
Cavallo
A
A
Parola
A
A
Robbiano
F
F
Cappello
N
N
Mancuso
M
M
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000628:therapy; D008172:Lung Diseases, Fungal / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use
D000935:Antifungal Agents; D013256:Steroids; D000666:Amphotericin B