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Aspergillus Infection in Lung Transplant Recipients With Cystic Fibrosis^*

Risk Factors and Outcomes Comparison to Other Types of Transplant Recipients

^* From the Department of Medicine (Drs. Helmi, Cornwell, and Meyer), Section of Pulmonary and Critical Care Medicine, and the Department of Surgery (Dr. Love and Ms. Welter), Section of Cardiothoracic Surgery, University of Wisconsin, Madison, WI.

Correspondence to: Keith C. Meyer, MD, FCCP, Department of Medicine, K4/930 Clinical Sciences Center, 600 Highland Ave, Madison, WI 53792-9988; e-mail: kcm{at}medicine.wisc.edu

Study objectives: To characterize Aspergillus infections in lung transplant recipients with cystic fibrosis (CF).

Design: A retrospective analysis of 32 consecutive lung transplant recipients with CF who underwent bilateral lung transplant at the University of Wisconsin from 1994 to 2000 to determine the incidence, risk factors, and consequences of Aspergillus infection. The findings were compared to 101 non-CF recipients of lung transplants (93) and heart-lung transplants (8) for other transplant indications.

Setting: A university hospital.

Patients or participants: Lung transplant recipients with CF or other indications for transplantation.

Interventions: None.

Measurements and results: Seventeen of 32 CF recipients (53%) had Aspergillus fumigatus isolated from their respiratory secretions prior to undergoing transplantation. Ten of these 17 (59%) recipients had A fumigatus persistently found in their respiratory secretions posttransplant vs 6 of 15 CF patients (40%) who had not been colonized pretransplant and 28 of 101 of the non-CF recipients (28%). Four of the preoperatively colonized CF recipients developed tracheobronchial aspergillosis (TBA) just distal to the bronchial anastomoses, and one recipient had dehiscence of the involved anastomosis. None of the CF recipients developed disseminated aspergillosis or pneumonia. Prophylactic antifungal therapy did not prevent TBA, and IV amphotericin B therapy was required to clear the infection in all four patients, with endobronchial debridement of necrotic tissue required in two of them. In contrast, 10 of the non-CF (10%) recipients developed Aspergillus infections posttransplant (TBA, 4 recipients; pneumonitis, 6 recipients), and only 3 patients had successful treatment and long-term survival (TBA, 2 patients; pneumonia, 1 patient). Donor lung ischemia time, cytomegalovirus infection or pneumonia, or pretransplant mechanical ventilation did not increase the risk of developing TBA in CF recipients.

Conclusions: The risk of TBA for patients receiving lung transplants for CF warrants early surveillance bronchoscopy to detect TBA, particularly in recipients with pretransplant colonization.

Key Words: Aspergillus • respiratory tract infection • lung transplantation