title: The Effectiveness of Culture-Directed Preemptive Anti-Aspergillus Treatment in Lung Transplant Recipients at One Year After Transplant.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is a significant complication after lung transplantation. However, the risk factors for IPA in patients colonized with Aspergillus species, and the effectiveness of culture-directed preemptive treatment, are not well known.
  
  
  METHODS
  We studied 328 lung transplant recipients, from January 2006 to July 2009, with 1-year follow-up. Risk factors and effectiveness of culture-directed preemptive treatment were evaluated via a Cox-proportional hazard model.
  
  
  RESULTS
  Seventy-one recipients (21.6%) developed invasive fungal infections, including 29 patients (8.8%) with IPA. Only 48.3% (14/29) of patients with IPA had pretransplantation or posttransplantation airway colonization with Aspergillus spp. In the Cox-proportional hazard model, treatment with rabbit antithymocyte globulin was significantly associated with posttransplant IPA in patients with Aspergillus colonization (hazards ratio, 4.25; 95% confidence interval, 1.09-16.6). Preemptive antifungal treatment for 3 months was significantly associated with a lower rate of IPA (0% [0/36] vs 18% [14/77]; P = 0.003, odds ratio, 0.8; 95% confidence interval, 0.7-0.9) but did not impact mortality.
  
  
  CONCLUSIONS
  Our data suggest that almost half the cases of IPA occurred in patients without pretransplantation or posttransplantation airway colonization with Aspergillus spp. Among patients with Aspergillus colonization, use of rabbit antithymocyte globulin was associated with 4-fold risk of subsequent development of IPA. Invasive pulmonary aspergillosis was an independent risk factor for 1-year mortality. Use of preemptive antifungal treatment for 3 months may be associated with significant reduction of IPA without influencing mortality.
authors.affiliation: 1 Division of Infectious Diseases, Transplant Infectious Diseases, Western University, London, ON, Canada. 2 Division of Infectious Diseases, Transplant Infectious Diseases, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 3 Toronto Lung Transplantation Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. 4 Department of Medical Microbiology and Infectious Diseases, Hôpital Saint-Luc, Montreal, QC, Canada. 5 Department of Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Hosseini-Moghaddam
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chaparro
authors.forename: Me-Linh
authors.initials: ML
authors.lastname: Luong
authors.forename: Sassan
authors.initials: S
authors.lastname: Azad
authors.forename: Lianne G
authors.initials: LG
authors.lastname: Singer
authors.forename: Tony
authors.initials: T
authors.lastname: Mazzulli
authors.forename: Coleman
authors.initials: C
authors.lastname: Rotstein
authors.forename: Shaf
authors.initials: S
authors.lastname: Keshavjee
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D000961:Antilymphocyte Serum / Q000009:adverse effects; D001230:Aspergillus / Q000145:classification / Q000187:drug effects* / Q000276:immunology / Q000302:isolation & purification; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016015:Logistic Models; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012137:Respiratory System / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents