Aspergillus infection in lung transplant patients: incidence and prognosis (original) (raw)

Abstract

Lung transplant recipients experience a particularly high incidence of Aspergillus infection in comparison with other solid-organ transplantations. This study was conducted to determine the incidence of Aspergillus colonisation and invasive aspergillosis, and the impact on long-term survival associated with Aspergillus infection. A retrospective study of 362 consecutive lung transplant patients from a single national centre who were transplanted 1992–2003 were studied. Twenty-seven patients were excluded due to incomplete or missing files. A total of 105/335 (31%) patients had evidence of Aspergillus infection (colonisation or invasion), including 83 (25%) patients with colonisation and 22 (6%) patients with radiographic or histological evidence of invasive disease. Most of the infections occurred within the first 3 months after transplantation. Cystic fibrosis (CF) patients had higher incidences of colonisation and invasive disease [15 (42%) and 4 (11%) of 36 patients] than non-CF patients [68 (23%) and 18 (6%) of 299 patients] (P = 0.01). Invasive aspergillosis was associated with 58% mortality after 2 years, whereas colonisation was not associated with early increased mortality but was associated with increased mortality after 5 years compared to non-infected patients (P < 0.05). An analysis of demographic factors showed that donor age [OR 1.40 per decade (95% CI 1.10-1.80)], ischaemia time [OR 1.17 per hour increase (95% CI 1.01–1.39)], and use of daclizumab versus polyclonal induction [OR 2.05 (95% CI 1.14–3.75)] were independent risk factors for Aspergillus infection. Invasive aspergillosis was associated with early and high mortality in lung transplant patients. Colonisation with Aspergillus was also associated with a significant increase in mortality after 5 years. CF patients have a higher incidence of Aspergillus infection than non-CF patients.

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Authors and Affiliations

  1. Department of Cardiology, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
    M. Iversen, C. M. Burton, J. Carlsen & N. Milman
  2. Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
    C. B. Andersen
  3. Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
    M. Tvede
  4. The Danish University of Pharmaceutical Sciences, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
    S. Vand, L. Skovfoged & M. Rasmussen
  5. Danish National Lung Transplant Programme, Department of Cardiology 2142, Division of Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
    M. Iversen

Authors

  1. M. Iversen
  2. C. M. Burton
  3. S. Vand
  4. L. Skovfoged
  5. J. Carlsen
  6. N. Milman
  7. C. B. Andersen
  8. M. Rasmussen
  9. M. Tvede

Corresponding author

Correspondence toM. Iversen.

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Iversen, M., Burton, C.M., Vand, S. et al. Aspergillus infection in lung transplant patients: incidence and prognosis.Eur J Clin Microbiol Infect Dis 26, 879–886 (2007). https://doi.org/10.1007/s10096-007-0376-3

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