Cahill B C, Hibbs J R, Savik K, Juni B A, Dosland B M, Edin-Stibbe C, Hertz M I
Thoracic Transplant Program, University of Minnesota, Minneapolis, USA.
Chest. 1997 Nov 5;112(5):1160-4. doi: 10.1378/chest.112.5.1160.
Invasive Aspergillus is an important cause of morbidity and mortality among lung transplant recipients. The diagnosis can be difficult and treatment is often unsuccessful so many centers preemptively treat all Aspergillus airway isolates to prevent invasive disease. This approach is untested as little is known about the relationship between Aspergillus airway colonization and invasive disease. This study was undertaken to evaluate the incidence of Aspergillus airway colonization after lung transplantation and the risk of invasive disease after colonization.
All cultures and histologic specimens obtained from a consecutive series of 151 lung transplant cases were reviewed for the presence of Aspergillus and compared with clinical data.
Aspergillus was isolated from the airway in 69 (46%) of 151 transplant recipients. Invasive disease occurred in five cases and was uniformly fatal, accounting for 13% of all posttransplant deaths. Results of cytologic examination of BAL fluid were normal in all cases of invasive disease and cultures were positive in only one of five patients prior to invasion. Invasive disease occurred exclusively in patients who died or were colonized with Aspergillus fumigatus within the first 6 months posttransplant. Patients growing A. fumigatus from the airway during the first 6 months were 11 times more likely to develop invasive disease relative to those not colonized.
Aspergillus airway colonization after lung transplantation is common and in most cases, transient. In contrast, invasive Aspergillus disease is less common, but fatal. Bronchoscopy with cytologic examination and fungal culture are not sensitive or timely predictors of invasive disease. Invasive Aspergillus occurred only in patients initially colonized with A. fumigatus within the first 6 months posttransplant. A trial of empiric anti-Aspergillus therapy limited to the first 6 months posttransplant may be warranted.
侵袭性曲霉病是肺移植受者发病和死亡的重要原因。诊断可能困难，治疗往往不成功，因此许多中心对所有气道分离出的曲霉进行预防性治疗以预防侵袭性疾病。由于对曲霉气道定植与侵袭性疾病之间的关系了解甚少，这种方法未经检验。本研究旨在评估肺移植后曲霉气道定植的发生率以及定植后发生侵袭性疾病的风险。
回顾了连续151例肺移植病例的所有培养物和组织学标本中曲霉的存在情况，并与临床数据进行比较。
151例移植受者中有69例（46%）气道分离出曲霉。5例发生侵袭性疾病，均死亡，占所有移植后死亡的13%。所有侵袭性疾病病例的支气管肺泡灌洗（BAL）液细胞学检查结果均正常，侵袭前5例患者中仅1例培养阳性。侵袭性疾病仅发生在移植后前6个月内死亡或被烟曲霉定植的患者中。移植后前6个月气道中培养出烟曲霉的患者发生侵袭性疾病的可能性是未定植患者的11倍。
肺移植后曲霉气道定植常见，且在大多数情况下是短暂的。相比之下，侵袭性曲霉病较少见，但致命。支气管镜检查及细胞学检查和真菌培养不是侵袭性疾病敏感或及时的预测指标。侵袭性曲霉病仅发生在移植后前6个月内最初被烟曲霉定植的患者中。可能有必要在移植后前6个月进行经验性抗曲霉治疗试验。
