Volume 24, Issue 6 e13986

ORIGINAL ARTICLE

Fungal infection and colonization in lung transplant recipients with chronic lung allograft dysfunction

Kelly M. Pennington,

Corresponding Author

Kelly M. Pennington

[email protected]

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA

Correspondence

Kelly M. Pennington, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Email: [email protected]

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Meghan Aversa,

Meghan Aversa

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

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Tereza Martinu,

Tereza Martinu

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

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Bradley Johnson,

Bradley Johnson

Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

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Shahid Husain,

Shahid Husain

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

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Kelly M. Pennington,

Corresponding Author

Kelly M. Pennington

[email protected]

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA

Correspondence

Kelly M. Pennington, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Email: [email protected]

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Meghan Aversa,

Meghan Aversa

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

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Tereza Martinu,

Tereza Martinu

Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

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Bradley Johnson,

Bradley Johnson

Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

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Shahid Husain,

Shahid Husain

Toronto Lung Transplant Program, Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada

Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada

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First published: 15 November 2022

https://doi.org/10.1111/tid.13986

Citations: 1

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Abstract

Background

The incidence and impact of de novo fungal airway colonization and infection in lung transplant recipients (LTRs) with known chronic lung allograft dysfunction (CLAD) has not been established. We aimed to determine the 1-year cumulative incidence and risk factors of de novo fungal colonization or infection in LTRs with CLAD and assess the impact of colonization or infection on post-CLAD survival.

Methods

Prospectively collected Toronto Lung Transplant Program database and chart review were used for double-LTRs who were diagnosed with CLAD from January 1, 2016 to January 1, 2020 and who were free of airway fungi within 1 year prior to CLAD onset. International Society for Heart and Lung Transplantation definitions were used to define clinical syndromes. Cox-Proportional Hazards Models were used for risk-factor analysis. Survival analysis could not be completed secondary to low number of fungal events; therefore, descriptive statistics were employed for survival outcomes.

Results

We found 186 LTRs diagnosed with CLAD meeting our inclusion criteria. The 1-year cumulative incidence for any fungal event was 11.8% (7.0% for infection and 4.8% for colonization). Aspergillus fumigatus was a causative pathogen in eight of 13 (61.5%) patients with infection and six of nine (66.7%) patients with colonization. No patients with fungal colonization post-CLAD developed fungal infection. Peri-CLAD diagnosis (3 months prior or 1 month after) methylprednisolone bolus (hazards ratio: 8.84, p = .001) increased the risk of fungal events. Most patients diagnosed with fungal infections (53.8%) died within 1-year of CLAD onset.

Conclusion

De novo IFIs and fungal colonization following CLAD onset were not common. Fungal colonization did not lead to fungal infection. Methylprednisolone bolus was a significant risk factors for post-CLAD fungal events.

CONFLICT OF INTEREST

The authors have any conflict of interest to disclose.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

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Citing Literature

Volume24, Issue6

December 2022

e13986