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1 From the Division of Transplantation Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
2 From the Division of Surgical Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA.
3 From the Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
David R. Nunley, MD, FCCP, Critical Care Medicine, University of Pittsburgh, 612 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261; e-mail: DDDNunley{at}aol.com
Study objective: To define the prevalence of colonization and infection of the lower respiratory tract (LRT) with Aspergillus in lung transplant recipients with and without cystic fibrosis (CF).
Design: Retrospective review.
Setting: Large university lung transplant center.
Materials and methods: The postoperative course of 31 CF and 53 non-CF double lung or double lobar transplant recipients receiving allografts from April 1991 to February 1996 was reviewed. All recipients were subjected to surveillance bronchoscopy and biopsy at predetermined intervals and when clinically indicated. BAL fluid (BALF) and biopsy material were examined by appropriate fungal culture and staining techniques. Infection was defined by the finding of tissue-invasive disease on biopsy specimens.
Results: Seven of the 31 CF recipients (22%) had Aspergillus isolated from cultures of sputum prior to transplantation. Following transplantation, 15 CF recipients (48%) had Aspergillus isolated from either sputum or BALF, including 4 of the 7 recipients identified with the fungus prior to transplantation. By contrast, 21 of the 53 non-CF recipients (40%) had Aspergillus isolated from the LRT following transplantation, none having had the fungus isolated prior to transplantation. The prevalence of Aspergillus did not differ between these groups (p = 0.51). Infections with Aspergillus occurred in 4 of the CF recipients (27%) and did not differ from the 3 infections (14%) identified in the non-CF recipients (p = 0.36). However, three of the four infections in the CF recipients involved the healing bronchial anastomosis and occurred prior to postoperative day 60. All three of these recipients had Aspergillus preoperatively. Postoperative infection was more common in the CF recipients having Aspergillus preoperatively than in those CF recipients without preoperative Aspergillus (p = 0.02).
Conclusions: Isolation of Aspergillus from the LRT following double lung transplantation is common and generally not associated with tissue-invasive disease. Those CF recipients with Aspergillus isolated in cultures of sputum preoperatively are at risk for postoperative infections with this agent. The healing bronchial anastomosis is particularly vulnerable.
Key Words: aspergillosis • Aspergillus • cystic fibrosis • lung transplantation
Submitted on December 8, 1997
Accepted on May 5, 1998
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