Chang Andrew, Musk Michael, Lavender Melanie, Wrobel Jeremy, Yaw Meow-Chong, Lawrence Sharon, Chirayath Shiji, Boan Peter
Departments of Infectious Diseases and Microbiology, Fiona Stanley Hospital and PathWest Laboratory Medicine WA, Perth, Australia.
Advanced Lung Disease and Lung Transplantation Unit, Fiona Stanley Hospital, Perth, Australia.
Transpl Infect Dis. 2019 Jun;21(3):e13085. doi: 10.1111/tid.13085. Epub 2019 Apr 16.
Invasive fungal infections (IFI) are common after lung transplantation with reported incidence of 8.1% to 16% at 12 months post-transplant, and 3-month all-cause mortality after IFI of 21.7%.
We performed a retrospective study of IFI and fungal colonization in lung transplants (LTs) from November 2004 to February 2017.
137 LTs were followed for a median 4.1 years (IQR 2.1-6.2 years). In addition to nebulized amphotericin for the transplant admission to all LTs, systemic mold-active azole was given to 80/130 (61.5%) LTs in the first 6 months post-transplant, 57/121 (47.1%) in the period 6-12 months after transplant, and 93/124 (75%) in the period more than 12 months post-transplant. Mold airways colonization was found in 81 (59.1%) LTs before and 110 (80.3%) LTs after transplantation. There were 13 IFIs for an overall incidence of 2.1 per 100 person-years, occurring at a median 583 days (IQR 182-1110 days) post-transplant, a cumulative incidence of 3.8% at 1 year, 7.6% at 3 years and 10.1% at 5 years post-transplant. All-cause 3-month mortality after IFI was 7.7%. Aspergillus species followed by Scedosporium apiospermum and Cryptococcus species were the commonest fungi causing IFI.
In our cohort the rate of IFI was comparatively low, likely because of comprehensive early antifungal use and preemptive therapy at any time after transplant. Prospective studies of fungal colonization late after LT are required to determine the risks and benefits of watchful waiting compared to preemptive therapy.
侵袭性真菌感染（IFI）在肺移植后很常见，据报道移植后12个月的发病率为8.1%至16%，IFI后3个月的全因死亡率为21.7%。
我们对2004年11月至2017年2月期间肺移植（LT）中的IFI和真菌定植进行了一项回顾性研究。
137例LT患者的中位随访时间为4.1年（四分位间距2.1 - 6.2年）。除了对所有LT患者在移植入院时雾化使用两性霉素外，80/130（61.5%）例LT患者在移植后的前6个月接受了全身性抗霉菌唑治疗，57/121（47.1%）例在移植后6 - 12个月期间接受治疗，93/124（75%）例在移植后超过12个月期间接受治疗。移植前81（59.1%）例LT患者和移植后110（80.3%）例LT患者发现有霉菌气道定植。共发生13例IFI，总发病率为每100人年2.1例，发生在移植后的中位时间为583天（四分位间距182 - 1110天），移植后1年的累积发病率为3.8%，3年为7.6%，5年为10.1%。IFI后3个月的全因死亡率为7.7%。引起IFI最常见的真菌依次为曲霉菌属、尖端赛多孢菌和隐球菌属。
在我们的队列中，IFI发生率相对较低，可能是因为早期全面使用抗真菌药物以及移植后随时进行抢先治疗。需要对LT术后晚期真菌定植进行前瞻性研究，以确定与抢先治疗相比，观察等待的风险和获益。
