Nunley D R, Ohori P, Grgurich W F, Iacono A T, Williams P A, Keenan R J, Dauber J H
Division of Transplantation Medicine, University of Pittsburgh Medical Center, PA, USA.
Chest. 1998 Nov;114(5):1321-9. doi: 10.1378/chest.114.5.1321.
To define the prevalence of colonization and infection of the lower respiratory tract (LRT) with Aspergillus in lung transplant recipients with and without cystic fibrosis (CF).
Retrospective review.
Large university lung transplant center.
The postoperative course of 31 CF and 53 non-CF double lung or double lobar transplant recipients receiving allografts from April 1991 to February 1996 was reviewed. All recipients were subjected to surveillance bronchoscopy and biopsy at predetermined intervals and when clinically indicated. BAL fluid (BALF) and biopsy material were examined by appropriate fungal culture and staining techniques. Infection was defined by the finding of tissue-invasive disease on biopsy specimens.
Seven of the 31 CF recipients (22%) had Aspergillus isolated from cultures of sputum prior to transplantation. Following transplantation, 15 CF recipients (48%) had Aspergillus isolated from either sputum or BALF, including 4 of the 7 recipients identified with the fungus prior to transplantation. By contrast, 21 of the 53 non-CF recipients (40%) had Aspergillus isolated from the LRT following transplantation, none having had the fungus isolated prior to transplantation. The prevalence of Aspergillus did not differ between these groups (p = 0.51). Infections with Aspergillus occurred in 4 of the CF recipients (27%) and did not differ from the 3 infections (14%) identified in the non-CF recipients (p = 0.36). However, three of the four infections in the CF recipients involved the healing bronchial anastomosis and occurred prior to postoperative day 60. All three of these recipients had Aspergillus preoperatively. Postoperative infection was more common in the CF recipients having Aspergillus preoperatively than in those CF recipients without preoperative Aspergillus (p = 0.02).
Isolation of Aspergillus from the LRT following double lung transplantation is common and generally not associated with tissue-invasive disease. Those CF recipients with Aspergillus isolated in cultures of sputum preoperatively are at risk for postoperative infections with this agent. The healing bronchial anastomosis is particularly vulnerable.
确定患有和未患有囊性纤维化（CF）的肺移植受者下呼吸道（LRT）曲霉菌定植和感染的患病率。
回顾性研究。
大型大学肺移植中心。
回顾了1991年4月至1996年2月期间接受同种异体移植的31例CF和53例非CF双肺或双叶移植受者的术后病程。所有受者在预定时间间隔以及临床指征出现时均接受监测支气管镜检查和活检。通过适当的真菌培养和染色技术检查支气管肺泡灌洗（BAL）液（BALF）和活检材料。感染定义为活检标本中发现组织侵袭性疾病。
31例CF受者中有7例（22%）在移植前痰培养中分离出曲霉菌。移植后，15例CF受者（48%）痰或BALF中分离出曲霉菌，其中包括移植前7例已鉴定出该真菌的受者中的4例。相比之下，53例非CF受者中有21例（40%）在移植后LRT中分离出曲霉菌，移植前均未分离出该真菌。这些组之间曲霉菌的患病率无差异（p = 0.51）。CF受者中有4例（27%）发生曲霉菌感染，与非CF受者中鉴定出的3例感染（14%）无差异（p = 0.36）。然而，CF受者中的4例感染中有3例累及愈合中的支气管吻合口，且发生在术后60天之前。这3例受者术前均有曲霉菌。术前有曲霉菌的CF受者术后感染比术前无曲霉菌的CF受者更常见（p = 0.02）。
双肺移植后LRT中分离出曲霉菌很常见，且通常与组织侵袭性疾病无关。术前痰培养中分离出曲霉菌的CF受者有术后感染该病原体的风险。愈合中的支气管吻合口尤其脆弱。
