Risk and outcomes of pulmonary fungal infection after pediatric lung transplantation

Evan Ammerman, Stuart C. Sweet, Matthew Fenchel, Gregory A. Storch, Carol Conrad, Don Hayes, Albert Faro, Samuel Goldfarb, Ernestina Melicoff, Marc Schecter, Gary Visner, Nikki M. Williams, Lara Danziger-Isakov

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking. Methods: NIH-sponsored Clinical Trials in Organ Transplantation in Children enrolled PLT candidates, collecting data prospectively for 2 years post-transplant. Demographics, signs/symptoms, radiology, pathology and microbiology were collected. Analyses evaluated for PFI-related risks and outcomes. Results: In 59 PLT, pre-transplant fungal colonization occurred in 6 donors and 15 recipients. Cystic fibrosis (CF) was associated with pre-transplant colonization (P <.01). Twenty-five (42%) PLT had 26 post-transplant colonizations (median = 67 days, range = 0-750 days) with Candida (13), Aspergillus (4), mold (6) or yeast (3). Post-PLT colonization was not associated with CF, age, or pre-PLT colonization. Thirteen PFIs occurred in 10 (17%) patients, 3 proven (Candida species) and 10 probable (Candida [3], Aspergillus [3], Penicillium [3], and mold [1]). Pulmonary fungal infection was preceded by post-PLT colonization with the same organism in 4 of 13 PFI, but post-PLT colonization did not predict subsequent PFI (P =.87). Older age at transplant was a risk for PFI (P <.01). No mortality was attributed to PFI. Prophylaxis use was not associated with decreased post-PLT colonization (P =.60) or PFI (P =.48). Conclusion: In PLT, PFI and fungal colonization are common but without associated mortality. Post-PLT colonization did not predict PFI. Optimal prevention strategies require additional study.

Original languageEnglish
Article numbere13100
JournalClinical Transplantation
Volume31
Issue number11
DOIs
StatePublished - Nov 2017

Keywords

  • fungal colonization
  • lung transplantation
  • pediatrics
  • prophylaxis
  • pulmonary fungal infection

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