Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis

Background: Whether nodular lesions have specific risk-factors or influence outcomes in lung transplant recipients with invasive aspergillosis, is not fully known. Methods: The study population consisted of 64 consecutive lung transplant recipients with proven or probable invasive aspergillosis. Nodules, with or without halo/air crescent-sign were considered nodular presentations. Outcomes assessed were response rate (successful versus unsuccessful outcome) and all-cause mortality at 12 weeks. Results: Overall, 34 patients had nodular and 30 had non-nodular lesions. Presence of nodular lesions was less likely to be associated with renal failure at baseline (adjusted OR 0.21, 95% CI, 0.04-0.97, p=0.047), CMV infection (adjusted OR 0.18, 95% CI 0.04-0.75, p=0.019) and receipt of antifungal prophylaxis (adjusted OR 0.22,95% CI, 0.06-0.88, p=0.032). Successful outcome and mortality rates in the study patients were 64.0% (41/64) and 25.0% (16/64), respectively. Nodular aspergillosis was associated with significantly higher successful outcome (adjusted OR 3.35, 95% CI, 1.06-10.54, p=0.039) and lower mortality at 12 weeks (adjusted OR 0.20, 0.05-0.78, p=0.021). Conclusions: Lung transplant recipients with nodular lesions due to invasive aspergillosis had better outcomes than those without such lesions. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.