title: Impact of mold infections in explanted lungs on outcomes of lung transplantation.
abstract: BACKGROUND
  Little is known about the incidence or significance of mold infections in the explanted lungs of lung transplant recipients.
  
  
  METHODS
  We reviewed the histopathology of the explanted lungs from 304 patients who underwent lung transplantation at our institution from 2005 to 2007 and received alemtuzumab induction therapy and posttransplant voriconazole prophylaxis.
  
  
  RESULTS
  Invasive mold infections were present in the explanted lungs of 5% (14 of 304) of patients, including chronic necrotizing pneumonias (n=7), mycetomas (n=4), and invasive fungal pneumonias (n=3). Only 21% (3 of 14) received immunosuppressive therapy within 1 year before lung transplantation, suggesting that lung damage itself predisposed patients to mold infections. The risk of mold infection was higher in patients with cystic fibrosis (11%, 4 of 35) than other underlying lung diseases (4%, 10 of 269). Pulmonary mold infections were not diagnosed or suspected in 57% (8 of 14) of patients. Despite secondary voriconazole prophylaxis, fungal infections developed in 43% (6 of 14) of patients with mold infections of the explanted lungs compared with 14% (42 of 290) of patients without mold infections (P=0.01). Three patients developed invasive fungal infections while on voriconazole prophylaxis and three developed fungal infections more than 8 months after the discontinuation of voriconazole. The mortality attributable to invasive fungal infections among patients with mold infections of the explanted lungs was 29% (4 of 14).
  
  
  CONCLUSIONS
  Invasive mold infections in the explanted lungs are often not recognized before lung transplantation and are associated with poor outcomes.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15251, USA.
authors.forename: Aniket
authors.initials: A
authors.lastname: Vadnerkar
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: Umit
authors.initials: U
authors.lastname: Celik
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Yousem
authors.forename: Dimitra
authors.initials: D
authors.lastname: Mitsani
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
authors.forename: Minh-Ly
authors.initials: ML
authors.lastname: Nguyen
authors.forename: Eun J
authors.initials: EJ
authors.lastname: Kwak
authors.forename: Joseph
authors.initials: J
authors.lastname: Pilewski
authors.forename: Fernanda P
authors.initials: FP
authors.lastname: Silveira
authors.forename: Maria
authors.initials: M
authors.lastname: Crespo
authors.forename: M Hong
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D016041:Heart-Lung Transplantation / Q000473:pathology; D006801:Humans; D015994:Incidence; D008168:Lung / Q000382:microbiology*; D016040:Lung Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000074323:Alemtuzumab; D065819:Voriconazole