Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation.
BACKGROUND
Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized.


METHODS
A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models.


RESULTS
Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8).


CONCLUSIONS
Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
Danziger-Isakov
Lara A
LA
Department of Pediatric Infectious Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA. danzigl@ccf.org
Worley
Sarah
S
Arrigain
Susana
S
Aurora
Paul
P
Ballmann
Manfred
M
Boyer
Debra
D
Conrad
Carol
C
Eichler
Irmgard
I
Elidemir
Okan
O
Goldfarb
Samuel
S
Mallory
George B
GB
Michaels
Marian G
MG
Michelson
Peter
P
Mogayzel
Peter J
PJ
Parakininkas
Daiva
D
Solomon
Melinda
M
Visner
Gary
G
Sweet
Stuart
S
Faro
Albert
A
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D009181:Mycoses / Q000401:mortality*; D011014:Pneumonia / Q000382:microbiology* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors