title: Isolation of Aspergillus species from the airway of lung transplant recipients is associated with excess mortality.
abstract: BACKGROUND
  Aspergillus spp. are the leading cause of invasive fungal infection in lung transplant recipients. We investigated the relationship between the isolation of Aspergillus spp. from the respiratory tract of lung transplant recipients and their risk of mortality.
  
  
  METHODS
  A retrospective, observational cohort study of all patients who received lung allografts between January 1999 and May 2011 at a single UK centre was performed. The time from transplantation to death was analysed using Cox regression models. Isolation of Aspergillus spp. from the respiratory tract was included as a covariate in the Cox regression model.
  
  
  RESULTS
  Two hundred-thirteen patients were included. The median follow-up time was 5 years during which 102 patients (47.9%) died. Aspergillus was isolated from 74 (34.7%) patients. Twenty patients (27%) had Aspergillus isolated in the first 60 days post-transplant. Forty-one patients (55.4%) in the Aspergillus group and 61 patients (43.9%) in the non-Aspergillus group died during follow-up. A hazard ratio of 2.2 (95% CI 1.5-3.3; P < 0.001) for death following a positive Aspergillus sample was observed.
  
  
  CONCLUSIONS
  Isolation of Aspergillus spp. from patients following lung transplantation is associated with a significant increase in mortality. Novel preventative strategies are required to minimise the impact of Aspergillus in lung transplant recipients.
authors.affiliation: The University of Manchester, Manchester Academic Health Science Centre, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK. timothy.felton@manchester.ac.uk
authors.forename: T W
authors.initials: TW
authors.lastname: Felton
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: B
authors.initials: B
authors.lastname: Isalska
authors.forename: S
authors.initials: S
authors.lastname: Brennan
authors.forename: A
authors.initials: A
authors.lastname: Philips
authors.forename: S
authors.initials: S
authors.lastname: Whiteside
authors.forename: H M
authors.initials: HM
authors.lastname: Doran
authors.forename: C
authors.initials: C
authors.lastname: Leonard
authors.forename: M
authors.initials: M
authors.lastname: Al-Aloul
authors.forename: N
authors.initials: N
authors.lastname: Yonan
authors.forename: W W
authors.initials: WW
authors.lastname: Hope
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality*; D001230:Aspergillus / Q000302:isolation & purification*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012137:Respiratory System / Q000382:microbiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014180:Transplantation; D006113:United Kingdom; D055815:Young Adult