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, Danziger-Isakov Lara
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Washington University in St. Louis, St. Louis, MO, USA.
Clin Transplant. 2017 Nov;31(11). doi: 10.1111/ctr.13100. Epub 2017 Sep 18.
Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking.
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.
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).
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.
缺乏前瞻性研究来确定小儿肺移植（PLT）后肺部真菌感染（PFI）的相关危险因素及相关结局。
美国国立卫生研究院资助的儿童器官移植临床试验纳入了PLT候选者，前瞻性收集移植后2年的数据。收集了人口统计学、体征/症状、放射学、病理学和微生物学数据。分析评估了与PFI相关的风险和结局。
在59例PLT中，6例供体和15例受者移植前发生真菌定植。囊性纤维化（CF）与移植前定植相关（P<0.01）。25例（42%）PLT发生了26次移植后定植（中位数=67天，范围=0 - 750天），定植菌为念珠菌（13例）、曲霉菌（4例）、霉菌（6例）或酵母菌（3例）。PLT后定植与CF、年龄或PLT前定植无关。10例（17%）患者发生了13次PFI，3例确诊（念珠菌属），10例可能（念珠菌[3例]、曲霉菌[3例]、青霉菌[3例]和霉菌[1例]）。13例PFI中有4例在PFI发生前有相同病原体的PLT后定植，但PLT后定植不能预测随后的PFI（P = 0.87）。移植时年龄较大是PFI的一个危险因素（P<0.01）。没有死亡归因于PFI。预防性用药与PLT后定植减少（P = 0.60）或PFI（P = 0.48）无关。
在PLT中，PFI和真菌定植很常见，但无相关死亡率。PLT后定植不能预测PFI。最佳预防策略需要进一步研究。
