title: Colonization with small conidia Aspergillus species is associated with bronchiolitis obliterans syndrome: a two-center validation study.
abstract: Aspergillus colonization after lung transplantation may increase the risk for bronchiolitis obliterans syndrome (BOS), a disease of small airways. We hypothesized that colonization with small conidia Aspergillus species would be associated with a greater risk of BOS, based upon an increased likelihood of deposition in small airways. We studied adult primary lung recipients from two large centers; 298 recipients at University of California, Los Angeles and 482 recipients at Duke University Medical Center. We grouped Aspergillus species by conidia diameter≤3.5 μm. We assessed the relationship of colonization with outcomes in Cox models. Pre-BOS colonization with small conidia Aspergillus species, but not large, was a risk factor for BOS (p=0.002, HR 1.44, 95% CI 1.14-1.82), along with acute rejection, single lung and Pseudomonas. Colonization with small conidia species also associated with risk of death (p=0.03, HR 1.30, 95% CI 1.03-1.64). Although other virulence traits besides conidia size may be important, we have demonstrated in two large independent cohorts that colonization with small conidia Aspergillus species increases the risk of BOS and death. Prospective evaluation of strategies to prevent Aspergillus colonization of small airways is warranted, with the goal of preserving lung allograft function as long as possible.
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: S S
authors: SS
authors: Weigt
authors: Department of Medicine, Duke University Medical Center, Durham, NC.
authors: C A Finlen
authors: CAF
authors: Copeland
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: A
authors: A
authors: Derhovanessian
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: M Y
authors: MY
authors: Shino
authors: Department of Medicine, Duke University Medical Center, Durham, NC.
authors: W A
authors: WA
authors: Davis
authors: Department of Medicine, Duke University Medical Center, Durham, NC.
authors: L D
authors: LD
authors: Snyder
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: A L
authors: AL
authors: Gregson
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: R
authors: R
authors: Saggar
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: J P
authors: JP
authors: Lynch
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: D J
authors: DJ
authors: Ross
authors: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: A
authors: A
authors: Ardehali
authors: Department of Biomathematics, University of California, Los Angeles, CA.
authors: R M
authors: RM
authors: Elashoff
authors: Department of Medicine, Duke University Medical Center, Durham, NC.
authors: S M
authors: SM
authors: Palmer
authors: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
authors: J A
authors: JA
authors: Belperio
mesh_terms: D000368:Aged; D001228:Aspergillosis / Q000150:complications* / Q000175:diagnosis; D001230:Aspergillus / Q000472:pathogenicity*; D001989:Bronchiolitis Obliterans / Q000209:etiology* / Q000382:microbiology; D002140:California; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D016016:Proportional Hazards Models; D011552:Pseudomonas Infections / Q000175:diagnosis; D012129:Respiratory Function Tests; D012307:Risk Factors; D013172:Spores, Fungal / Q000472:pathogenicity
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