Parize Perrine, Boussaud Veronique, Poinsignon Vianney, Sitterlé Emilie, Botterel Francoise, Lefeuvre Sandrine, Guillemain Romain, Dannaoui Eric, Billaud Eliane M
Department of Mycology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
Paris Descartes University, Paris, France.
Transpl Infect Dis. 2017 Oct;19(5). doi: 10.1111/tid.12738. Epub 2017 Aug 1.
Fungi of the genus Scedosporium are emerging pathogens responsible for severe infections in lung transplant recipients. These infections are associated with poor prognosis and some centers consider now Scedosporium species colonization as a contraindication to lung transplantation (LT) even though no published evidence demonstrates that Scedosporium species colonization is associated with higher morbidity or mortality after LT.
Here, we aim to describe characteristics and outcome of cystic fibrosis (CF) lung transplant recipients colonized with Scedosporium species in a single center over a 15-year period.
During the study period, 14 patients had scedosporial colonization reported. Only one patient, colonized before transplantation by Lomentospora prolificans, developed scedosporial disease. Among the eight patients colonized before transplantation by Scedosporium apiospermum complex, the median survival was 1.92 year (range 0.21-12.5). All these patients except one became free of fungal colonization after transplantation with antifungal prophylaxis including voriconazole or posaconazole. For the five patients colonized after LT, including two with L. prolificans, the median survival was 1.75 years (range 0.1-13); three of them are still alive.
It appears to us that scedosporial colonization may not be a contraindication for LT in CF patients, as long as S. apiospermum complex is involved and a life-long azole prophylaxis prescribed.
帚霉属真菌是新兴的病原体，可导致肺移植受者发生严重感染。这些感染与预后不良相关，一些中心现在将帚霉属真菌定植视为肺移植（LT）的禁忌证，尽管尚无公开证据表明帚霉属真菌定植与肺移植后更高的发病率或死亡率相关。
在此，我们旨在描述一个中心15年间囊性纤维化（CF）肺移植受者中帚霉属真菌定植的特征和结局。
在研究期间，有14例患者报告有帚霉定植。只有1例在移植前被多育弯孢霉定植的患者发生了帚霉病。在8例移植前被阿氏帚霉复合体定植的患者中，中位生存期为1.92年（范围0.21 - 12.5年）。除1例患者外，所有这些患者在接受包括伏立康唑或泊沙康唑在内的抗真菌预防治疗后，移植后均未再发生真菌定植。对于5例肺移植后定植的患者，包括2例被多育弯孢霉定植的患者，中位生存期为1.75年（范围0.1 - 13年）；其中3例仍然存活。
在我们看来，只要涉及阿氏帚霉复合体且给予终身唑类预防治疗，帚霉定植可能不是CF患者肺移植的禁忌证。
