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Risk and outcomes of pulmonary fungal infection after pediatric lung transplantation
Author(s) -
Ammerman Evan,
Sweet Stuart C.,
Fenchel Matthew,
Storch Gregory A.,
Conrad Carol,
Hayes Don,
Faro Albert,
Goldfarb Samuel,
Melicoff Ernestina,
Schecter Marc,
Visner Gary,
Williams Nikki M.,
DanzigerIsakov Lara
Publication year - 2017
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13100
Subject(s) - medicine , colonization , cystic fibrosis , lung transplantation , transplantation , microbiology and biotechnology , biology
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 PFI s 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.