Lack of association of Aspergillus colonization with the development of bronchiolitis obliterans syndrome in lung transplant recipients: An international cohort study

被引：12

作者：

Law, Nancy ^{[1
]}

Hamandi, Bassem ^{[2
,3
]}

Fegbeutel, Christine ^{[4
]}

Silveira, Fernanda P. ^{[5
]}

Verschuuren, Erik A. ^{[6
]}

Ussetti, Piedad ^{[7
]}

Chin-Hong, Peter V. ^{[8
]}

Sole, Amparo ^{[9
]}

Holmes-Liew, Chien-Li ^{[10
,11
]}

Billaud, Eliane M. ^{[12
]}

Grossi, Paolo A. ^{[13
]}

Manuel, Oriol ^{[14
,15
]}

Levine, Deborah J. ^{[16
]}

Barbers, Richard G. ^{[17
]}

Hadjiliadis, Denis ^{[18
]}

Younus, Muhammad ^{[19
]}

Aram, Jay ^{[19
]}

Chaparro, Cecilia ^{[20
]}

Singer, Lianne G. ^{[20
]}

Husain, Shahid ^{[1
]}

机构：

[1] Univ Toronto, Univ Hlth Network, Multiorgan Transplant Program, Div Infect Dis, 585 Univ Ave,11 PMB 138, Toronto, ON M5G 2N2, Canada

[2] Univ Hlth Network, Dept Pharm, Toronto, ON, Canada

[3] Univ Toronto, Leslie Dan Fac Pharm, Toronto, ON, Canada

[4] Hannover Med Sch, Dept Cardiothorac Transplant & Vasc Surg, Hannover, Lower Saxony, Germany

[5] Univ Pittsburgh, Med Ctr, Div Infect Dis, Pittsburgh, PA USA

[6] Univ Groningen, Dept Pulm Dis, Univ Med Ctr Groningen, Groningen, Netherlands

[7] Hosp Puerta di Hierro, Resp Dept, Madrid, Spain

[8] Univ Calif San Francisco, Dept Med, San Francisco, CA 94143 USA

[9] Univ Valencia, Univ & Polytech Hosp La Fe, Resp Dept, Valencia, Spain

[10] Royal Adelaide Hosp, Lung Res, Hanson Inst, Adelaide, SA, Australia

[11] Royal Adelaide Hosp, Dept Thorac Med, Adelaide, SA, Australia

[12] Hop Europeen Georges Pompidou, AP HP, Serv Pharmacol, Paris, France

[13] Univ Insubria, Dept Infect Dis, Varese, Italy

[14] Univ Hosp Lausanne, Transplantat Ctr, Lausanne, Switzerland

[15] Univ Hosp Lausanne, Infect Dis Serv, Lausanne, Switzerland

[16] Univ Texas Hlth Sci Ctr San Antonio, Div Pulm & Crit Care Med, San Antonio, TX 78229 USA

[17] Univ Southern Calif, Keck Sch Med, Div Pulm & Crit Care, Los Angeles, CA USA

[18] Univ Penn, Dept Med, Hosp Univ Penn, Philadelphia, PA 19104 USA

[19] Pfizer Inc, New York, NY USA

[20] Univ Hlth Network, Toronto Lung Transplant Program, Toronto, ON, Canada

来源：

JOURNAL OF HEART AND LUNG TRANSPLANTATION | 2019年 / 38卷 / 09期

关键词：

lung transplantation; aspergillus; colonization; risk factors; BOS; MINIMAL ACUTE REJECTION; RESPIRATORY VIRAL-INFECTIONS; SYNDROME COMPLICATING LUNG; NECROSIS-FACTOR-ALPHA; OFFICIAL ADULT LUNG; RISK-FACTORS; GALACTOMANNAN ANTIGEN; INCREASES RISK; HEART; CYTOMEGALOVIRUS;

D O I：

10.1016/j.healun.2019.06.007

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is a major limitation in the long-term survival of lung transplant recipients (LTRs). However, the risk factors in the development of BOS remain undetermined. We conducted an international cohort study of LTRs to assess whether Aspergillus colonization with large or small conidia is a risk factor for the development of BOS. METHODS: Consecutive LTRs from January 2005 to December 2008 were evaluated. Rates of BOS and associated risk factors were recorded at 4 years. International Society of Heart and Lung Transplantation criteria were used to define fungal and other infections. A Cox proportional-hazards-model was constructed to assess the association between Aspergillus colonization and the development of BOS controlling for confounders. RESULTS: A total of 747 LTRs were included. The cumulative incidence of BOS at 4 years after transplant was 33% (250 of 747). Additionally, 22% of LTRs experienced Aspergillus colonization after transplantation. Aspergillus colonization with either large (hazard ratio [HR] = 0.6, 95% confidence interval [CI] = 0.3-1.2, p = 0.12) or small conidia (HR = 0.9, 95% CI = 0.6-1.4, p = 0.74) was not associated with the development of BOS. Factors associated with increased risk of development of BOS were the male gender (HR = 1.4, 95% CI = 1.1-1.8, p = 0.02) and episodes of acute rejection (1-2 episodes, HR = 1.5, 95% CI = 1.1-2.1, p = 0.014; 3-4 episodes, HR = 1.6, 95% CI = 1.0-2.6, p = 0.036; >4 episodes, HR = 2.2, 95% CI = 1.1-4.3, p = 0.02), whereas tacrolimus use was associated with reduced risk of BOS (HR = 0.6, 95% CI = 0.5-0.9, p = 0.007). CONCLUSIONS: We conclude from this large multicenter cohort of lung transplant patients, that Aspergillus colonization with large or small conidia did not show an association with the development of BOS. (C) 2019 International Society for Heart and Lung Transplantation. All rights reserved.

引用

页码：963 / 971

页数：9

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