title: Pretransplant Aspergillus colonization of cystic fibrosis patients and the incidence of post-lung transplant invasive aspergillosis.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is an important cause of morbidity and mortality among patients undergoing lung transplant. Cystic fibrosis-lung transplant recipients (CF-LTRs) may be at greater risk of IA following lung transplantation because of the presence of Aspergillus in their airways before transplantation. This study evaluated the impact of pretransplant Aspergillus colonization on the risk for IA among CF-LTRs.
  
  
  METHODS
  A single-center retrospective cohort study of CF-LTRs was conducted between 2006 and 2010. Respiratory tract cultures before transplantation were reviewed to identify patients with pretransplant Aspergillus colonization. Patients with positive Aspergillus sputum culture or positive bronchoalvelolar lavage (BAL) galactomannan after transplantation were classified as having colonization or disease according to the International Society of Heart and Lung Transplantation criteria.
  
  
  RESULTS
  A total of 93 CF patients underwent lung transplantation. Seventy percent (65/93) of CF-LTRs had pretransplant Aspergillus colonization. Thirty-six patients had positive intraoperative Aspergillus culture from the native lung BAL. Overall, 22.5% (20/93) of CF-LTRs developed IA. Median time to IA was 42 days following transplantation. Positive intraoperative Aspergillus culture (OR 4.36, 95% CI 1.35-14.05, P=0.01) and treatment for acute cellular rejection within 90 days after transplantation (OR 3.53, 95% CI 1.03-12.15, P=0.05) were independent risk factors for IA. Antifungal prophylaxis was administered to 61% (57/93) of CF-LTRs. One-year mortality rate was 16% (15/93). IA was not associated with increased risk of death (OR 2.10, 95% CI 0.62-7.06, P=0.23).
  
  
  CONCLUSIONS
  Pretransplant Aspergillus colonization is frequent among CF-LTRs and a positive intraoperative Aspergillus culture produced a fourfold higher risk of developing IA.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, University of Toronto, University Health Network, Toronto, Ontario, Canada. 2 Division of Respirology, Toronto Lung Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada. 3 Adult Cystic Fibrosis Centre and Department of Respiratory Medicine, University of Toronto, St Michael's Hospital, Toronto, Canada. 4 Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada. 5 Division of Thoracic Surgery, Toronto Lung Transplant Program, University of Toronto, University Health Network, Toronto, Ontario, Canada. 6 University of Toronto, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada. 7 Address correspondence to: Shahid Husain, M.D., Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto General Hospital, NCSB, 11th floor, 11c-1269, 585 University Avenue, Toronto, ON, Canada M5G 2N2.
authors.forename: Me-Linh
authors.initials: ML
authors.lastname: Luong
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.forename: Anne
authors.initials: A
authors.lastname: Stephenson
authors.forename: Coleman
authors.initials: C
authors.lastname: Rotstein
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.forename: Valerie
authors.initials: V
authors.lastname: Waters
authors.forename: Sassan
authors.initials: S
authors.lastname: Azad
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tullis
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000472:pathogenicity*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications* / Q000453:epidemiology; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents