Aspergillus infection in lung transplant patients: incidence and prognosis.
Lung transplant recipients experience a particularly high incidence of Aspergillus infection in comparison with other solid-organ transplantations. This study was conducted to determine the incidence of Aspergillus colonisation and invasive aspergillosis, and the impact on long-term survival associated with Aspergillus infection. A retrospective study of 362 consecutive lung transplant patients from a single national centre who were transplanted 1992-2003 were studied. Twenty-seven patients were excluded due to incomplete or missing files. A total of 105/335 (31%) patients had evidence of Aspergillus infection (colonisation or invasion), including 83 (25%) patients with colonisation and 22 (6%) patients with radiographic or histological evidence of invasive disease. Most of the infections occurred within the first 3 months after transplantation. Cystic fibrosis (CF) patients had higher incidences of colonisation and invasive disease [15 (42%) and 4 (11%) of 36 patients] than non-CF patients [68 (23%) and 18 (6%) of 299 patients] (P = 0.01). Invasive aspergillosis was associated with 58% mortality after 2 years, whereas colonisation was not associated with early increased mortality but was associated with increased mortality after 5 years compared to non-infected patients (P < 0.05). An analysis of demographic factors showed that donor age [OR 1.40 per decade (95% CI 1.10-1.80)], ischaemia time [OR 1.17 per hour increase (95% CI 1.01-1.39)], and use of daclizumab versus polyclonal induction [OR 2.05 (95% CI 1.14-3.75)] were independent risk factors for Aspergillus infection. Invasive aspergillosis was associated with early and high mortality in lung transplant patients. Colonisation with Aspergillus was also associated with a significant increase in mortality after 5 years. CF patients have a higher incidence of Aspergillus infection than non-CF patients.
Iversen
M
M
Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark. maiv@rh.dk
Burton
C M
CM
Vand
S
S
Skovfoged
L
L
Carlsen
J
J
Milman
N
N
Andersen
C B
CB
Rasmussen
M
M
Tvede
M
M
D000328:Adult; D000368:Aged; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D001230:Aspergillus; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors