Invasive fungal infections after respiratory viral infections in lung transplant recipients are associated with lung allograft failure and chronic lung allograft dysfunction within 1 year

被引：7

作者：

Permpalung, Nitipong ^{[1
,2
]}

Liang, Tao ^{[1
]}

Gopinath, Shilpa ^{[1
]}

Bazemore, Katrina ^{[3
]}

Mathew, Joby ^{[3
]}

Ostrander, Darin ^{[1
]}

Durand, Christine M. ^{[1
]}

Shoham, Shmuel ^{[1
]}

Zhang, Sean X. ^{[4
]}

Marr, Kieren A. ^{[1
,5
]}

Avery, Robin K. ^{[1
]}

Shah, Pali D. ^{[3
]}

机构：

[1] Johns Hopkins Univ, Dept Med, Div Infect Dis, Sch Med, 601 N Wolfe St, Carnegie Buldg room 340, Baltimore, MD 21205 USA

[2] Chulalongkorn Univ, Fac Med, Dept Microbiol, Div Mycol, Bangkok, Thailand

[3] Johns Hopkins Univ, Dept Med, Div Pulm & Crit Care, Sch Med, Baltimore, MD 21205 USA

[4] Johns Hopkins Univ, Dept Pathol, Div Med Microbiol, Sch Med, Baltimore, MD 21205 USA

[5] Pearl Diagnost Inc, Baltimore, MD USA

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2023年 / 42卷 / 07期

关键词：

chronic lung allograft dysfunction; fungal-after-viral infection; invasive fungal infection; lung allograft failure; lung transplant; respiratory viral infection; BRONCHIOLITIS OBLITERANS SYNDROME; PULMONARY ASPERGILLOSIS; INTERNATIONAL SOCIETY; WORKING FORMULATION; COVID-19; STANDARDIZATION; COLONIZATION; HEART;

D O I：

10.1016/j.healun.2023.02.005

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Respiratory viral infections (RVI) are associated with chronic lung allograft dysfunc-tion (CLAD) and mortality in lung transplant recipients (LTRs). However, the prevalence and impact of secondary invasive fungal infections (IFIs) post RVIs in LTRs have not been investigated. METHODS: We performed a single center retrospective study including LTRs diagnosed with 5 different respiratory viral pathogens between January 2010 to May 2021 and evaluated their clinical outcomes in 1 year. The risk factors of IFIs were evaluated by logistic regression. The impact of IFIs on CLAD stage progression/death was examined by Cox regression. RESULTS: A total of 202 RVI episodes (50 influenza, 31 severe acute respiratory syndrome coro-navirus-2, 30 metapneumovirus, 44 parainfluenza, and 47 respiratory syncytial virus) in 132 patients was included for analysis. Thirty-one episodes (15%) were associated with secondary IFIs, and 27 occurred in LTRs with lower respiratory tract infection (LRTI; 28% from 96 LRTI episodes). Aspergillosis was the most common IFI (80%). LTRs with IFIs had higher disease severity during RVI episodes. In multivariable analysis, RVI with LTRI was associated with IFI (adjusted odds ratio [95% confidence interval (CI)] of 7.85 (2.48-24.9). Secondary IFIs were associated with CLAD stage progression/death after accounting for LRTI, pre-existing CLAD, intensive care unit admission, secondary bacterial pneumonia and underlying lung diseases pre -transplant with adjusted hazard ratio (95%CI) of 2.45 (1.29-4.64). CONCLUSIONS: This cohort demonstrated 15% secondary IFI prevalence in LTRs with RVIs. Impor-tantly, secondary IFIs were associated with CLAD stage progression/death, underscoring the impor-tance of screening for fungal infections in this setting. J Heart Lung Transplant 2023;42:953-963 & COPY; 2023 International Society for Heart and Lung Transplantation. All rights reserved

引用

页码：953 / 963

页数：11

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