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Spectrum of Aspergillus Infection in Lung Transplant Recipients^*

Case Series and Review of the Literature

^* From the Department of Medicine (Drs. Mehrad, Paciocco, Martinez, Clark Ojo, and Lynch), Division of Pulmonary and Critical Care Medicine, and Department of Surgery (Dr. Iannettoni), Section of Thoracic Surgery, University of Michigan Medical School, Ann Arbor, MI.

Correspondence to: Joseph P. Lynch III, MD, FCCP, Medical Director, Lung Transplantation Program, University of Michigan Medical Center, 3916 Taubman Center, Box 0360, Ann Arbor, MI 48109-0360

Study objectives: (1) To define the incidence and natural history of Aspergillus colonization and infection in lung transplant recipients, and (2) to assess the impact of prophylaxis, surveillance, and therapy on the incidence and outcome of the disease.

Design: Retrospective review of 133 consecutive single or bilateral lung transplantations performed at a single institution, and review of the published literature.

Results: Airway colonization, isolated tracheobronchitis, and invasive pneumonia due to Aspergillus species occurred in 29%, 5%, and 8% of our series, and in 26%, 4%, and 5% of the pooled published data (all series, including ours), respectively. Greater than 50% of all diagnoses were made in the first 6 months after transplantation in both our series and the published literature. Incidence of progression from airway colonization to invasive disease was 1 in 38 in our series and 3 of 97 (3%) in the pooled published data. In patients with isolated tracheobronchitis, all 6 patients in our series and 41 of 50 patients (82%) in all published series, including ours, responded to antifungal therapy and/or surgical debridement. Among patients with invasive pneumonia or disseminated disease, however, 5 of 10 patients in our series and 26 of 64 patients (41%) in the pooled series survived their infection.

Conclusions: The role of antifungal therapy in Aspergillus airway colonization in lung transplant recipients is unclear. Data support a strategy of scheduled screening bronchoscopy followed by aggressive treatment for isolated Aspergillus tracheobronchitis in lung transplant recipients.

Key Words: Aspergillosis • fungal • immunocompromised host • lung diseases • lung transplantation

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