title: Saprophytic fungal infections and complications involving the bronchial anastomosis following human lung transplantation.
abstract: OBJECTIVE
  To demonstrate an association between saprophytic fungal infections occurring at the bronchial anastomosis (BA) and the development of additional complications arising at this site.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  University lung transplant center.
  
  
  METHODS
  Review of all single-lung and double-lung transplant (LTX) recipients who underwent transplantation between June 1993 and December 2000. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Bronchial wash fluid and biopsy material were examined using appropriate fungal stains and culture techniques. An infection was defined when fungal organisms were identified in tissue specimens.
  
  
  RESULTS
  Fifteen saprophytic fungal infections involving the BA were identified in 61 LTX recipients (24.6%) who survived a minimum of 75 days post-transplantation. Infections were attributed to Aspergillus sp (n = 9), Candida sp (n = 2), Torulopsis sp (n = 1), and mixed flora (ie, Penicillium + Candida, two patients; and Aspergillus + Candida, one patient). Saprophytic fungal infections occurred by a median of postoperative day 35 (range, 13 to 159 days). Airway complications involving the BA ultimately developed in 11 of 61 recipients (18%). These complications included symptomatic bronchial stenosis (nine patients), bronchomalacia (one patient), and fatal hemorrhage (one patient). Bronchial complications arose in 7 of 15 recipients (46.7%) with saprophytic fungal infections of the BA in contrast to 4 of 46 (8.7%) without infections (p = 0.003, Fisher exact test). Also demonstrated was a positive correlation between anastomotic infections and bronchial complications (Phi coefficient = 0.43; p = 0.001), while logistic regression analysis revealed that the absence of anastomotic infections predicted the absence of such complications (p = 0.002). The risk of developing an additional complication following an anastomotic infection in patients with infections was five times that of those recipients without an infection (relative risk, 5.36; 95% confidence interval [CI], 1.82 to 15.79). The odds in favor of a bronchial complication following an infection were eight times greater than in those recipients without infection (odds ratio, 8.31; 95% CI, 1.96 to 35.16).
  
  
  CONCLUSIONS
  Following LTX, saprophytic fungal infections of the BA are associated with serious airway complications.
authors.affiliation: Department of Internal Medicine, Andrew J. McKelvey Lung Transplantation Center, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA 30322, USA. david_nunley@emory.org
authors.forename: David R
authors.initials: DR
authors.lastname: Nunley
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Gal
authors.forename: J David
authors.initials: JD
authors.lastname: Vega
authors.forename: Carl
authors.initials: C
authors.lastname: Perlino
authors.forename: Pauline
authors.initials: P
authors.lastname: Smith
authors.forename: E Clinton
authors.initials: EC
authors.lastname: Lawrence
mesh_terms: D000328:Adult; D017677:Age Distribution; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology*; D001707:Biopsy, Needle; D001980:Bronchi / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D003453:Cryptococcosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008172:Lung Diseases, Fungal / Q000209:etiology* / Q000382:microbiology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution