Retrospective review.
SETTING: University lung transplant center.
MATERIALS AND METHODS: Review of all single-lung and double-lung transplant (LTX) recipients who underwent
transplantation between June 1993 and December 2000. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Bronchial wash fluid and biopsy material were examined using appropriate fungal stains and culture techniques. An
infection was defined when fungal organisms were identified in tissue specimens.
RESULTS: Fifteen saprophytic
fungal infections involving the BA were identified in 61 LTX recipients (24.6%) who survived a minimum of 75 days post-
transplantation.
Infections were attributed to Aspergillus sp (n = 9), Candida sp (n = 2),
Torulopsis sp (n = 1), and mixed flora (ie, Penicillium + Candida, two patients; and Aspergillus + Candida, one patient). Saprophytic
fungal infections occurred by a median of postoperative day 35 (range, 13 to 159 days). Airway complications involving the BA ultimately developed in 11 of 61 recipients (18%). These complications included symptomatic bronchial
stenosis (nine patients),
bronchomalacia (one patient), and fatal
hemorrhage (one patient). Bronchial complications arose in 7 of 15 recipients (46.7%) with saprophytic
fungal infections of the BA in contrast to 4 of 46 (8.7%) without
infections (p = 0.003, Fisher exact test). Also demonstrated was a positive correlation between anastomotic
infections and bronchial complications (Phi coefficient = 0.43; p = 0.001), while logistic regression analysis revealed that the absence of anastomotic
infections predicted the absence of such complications (p = 0.002). The risk of developing an additional complication following an anastomotic
infection in patients with
infections was five times that of those recipients without an
infection (relative risk, 5.36; 95% confidence interval [CI], 1.82 to 15.79). The odds in favor of a bronchial complication following an
infection were eight times greater than in those recipients without
infection (odds ratio, 8.31; 95% CI, 1.96 to 35.16).
CONCLUSIONS: