Singh Nina, Husain Shahid
Veterans Affairs Medical Center and University of Pittsburgh Medical Center, Thomas E Starzl Transplantation Institute, Pittsburgh, Pennsylvania 15240, USA. nis5+@pitt.edu
J Heart Lung Transplant. 2003 Mar;22(3):258-66. doi: 10.1016/s1053-2498(02)00477-1.
Invasive aspergillosis is a serious opportunistic infection in lung transplant recipients. It has not been fully discerned whether there are differences in the characteristics, risk factors and outcome of Aspergillus infection in single as compared with bilateral lung transplant recipients.
English-language articles identified by a MEDLINE search through December 2000 and bibliographies were used as data sources to identify cases of Aspergillus infections in lung transplant recipients. The studies selected had to have provided a definition of invasive aspergillosis to distinguish colonization from infection.
The median incidence of Aspergillus infections in lung transplant recipients was 6.2%. In total, 58% (45 of 78) of the Aspergillus infections were tracheobronchitis or bronchial anastomotic infections, 32% (25 of 78) were invasive pulmonary, and 22% (25 of 78) were disseminated infections. Single lung transplant recipients with Aspergillus infections were significantly older (p = 0.006), more likely to have had chronic obstructive pulmonary disease as an underlying illness (p = 0.05), more likely to have developed Aspergillus infections later after transplantation (p = 0.019), and tended to have a higher incidence of invasive aspergillosis (p = 0.11) than all other lung transplant recipients. Overall mortality in lung transplant recipients with Aspergillus infections was 52%. Single lung transplant recipients (p = 0.03), and patients with late-onset infections (occurring at least 3 months after transplantation ([p = 0.045]) infections had significantly higher mortality.
Single lung transplant recipients with Aspergillus infections had an overall greater morbidity and poorer outcome than other types of lung transplant recipients. Recognition of the unique characteristics of Aspergillus infections in single lung (vs bilateral or heart-lung) transplant recipients has implications relevant for the management of lung transplant recipients with aspergillosis.
侵袭性曲霉病是肺移植受者中一种严重的机会性感染。单肺移植受者与双肺移植受者相比，曲霉感染在特征、危险因素及转归方面是否存在差异尚未完全明确。
通过检索MEDLINE截至2000年12月的英文文献及参考文献作为数据源，以确定肺移植受者曲霉感染病例。入选的研究需提供侵袭性曲霉病的定义以区分定植与感染。
肺移植受者曲霉感染的中位发病率为6.2%。总共78例曲霉感染中，58%（45例）为气管支气管炎或支气管吻合口感染，32%（25例）为侵袭性肺部感染，22%（25例）为播散性感染。发生曲霉感染的单肺移植受者年龄显著更大（p = 0.006），更有可能以慢性阻塞性肺疾病作为基础疾病（p = 0.05），移植后更晚发生曲霉感染（p = 0.019），且侵袭性曲霉病的发病率往往更高（p = 0.11）。有曲霉感染的肺移植受者总体死亡率为52%。单肺移植受者（p = 0.03）以及发生迟发性感染（移植后至少3个月发生[p = 0.045]）的患者死亡率显著更高。
发生曲霉感染的单肺移植受者总体发病率更高，转归更差。认识单肺（相对于双肺或心肺）移植受者曲霉感染的独特特征，对于曲霉病肺移植受者的管理具有重要意义。
