title: Aspergillus colonization of the lung allograft is a risk factor for bronchiolitis obliterans syndrome.
abstract: Multiple infections have been linked with the development of bronchiolitis obliterans syndrome (BOS) post-lung transplantation. Lung allograft airway colonization by Aspergillus species is common among lung transplant recipients. We hypothesized that Aspergillus colonization may promote the development of BOS and may decrease survival post-lung transplantation. We reviewed all lung transplant recipients transplanted in our center between January 2000 and June 2006. Bronchoscopy was performed according to a surveillance protocol and when clinically indicated. Aspergillus colonization was defined as a positive culture from bronchoalveolar lavage or two sputum cultures positive for the same Aspergillus species, in the absence of invasive pulmonary Aspergillosis. We found that Aspergillus colonization was strongly associated with BOS and BOS related mortality in Cox regression analyses. Aspergillus colonization typically preceded the development of BOS by a median of 261 days (95% CI 87-520). Furthermore, in a multivariate Cox regression model, Aspergillus colonization was a distinct risk factor for BOS, independent of acute rejection. These data suggest a potential causative role for Aspergillus colonization in the development of BOS post-lung transplantation and raise the possibility that strategies aimed to prevent Aspergillus colonization may help delay or reduce the incidence of BOS.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. sweigt@mednet.ucla.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Weigt
authors.forename: R M
authors.initials: RM
authors.lastname: Elashoff
authors.forename: C
authors.initials: C
authors.lastname: Huang
authors.forename: A
authors.initials: A
authors.lastname: Ardehali
authors.forename: A L
authors.initials: AL
authors.lastname: Gregson
authors.forename: B
authors.initials: B
authors.lastname: Kubak
authors.forename: M C
authors.initials: MC
authors.lastname: Fishbein
authors.forename: R
authors.initials: R
authors.lastname: Saggar
authors.forename: M P
authors.initials: MP
authors.lastname: Keane
authors.forename: R
authors.initials: R
authors.lastname: Saggar
authors.forename: J P
authors.initials: JP
authors.lastname: Lynch
authors.forename: D A
authors.initials: DA
authors.lastname: Zisman
authors.forename: D J
authors.initials: DJ
authors.lastname: Ross
authors.forename: J A
authors.initials: JA
authors.lastname: Belperio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000517:prevention & control; D001230:Aspergillus / Q000472:pathogenicity*; D001989:Bronchiolitis Obliterans / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000382:microbiology*; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000935:Antifungal Agents