Risk of Lung Allograft Dysfunction Associated With Aspergillus Infection

Jérôme Le Pavec, MD; Pauline Pradère, MD; Anne Gigandon, MD; Gaëlle Dauriat, MD; Amélie Dureault, MD; Claire Aguilar, MD; Benoît Henry, MD; Fanny Lanternier, MD; Laurent Savale, MD,; Samuel Dolidon, MD; Pierre Gazengel, MD; Sacha Mussot, MD; Olaf Mercier, MD; Shahid Husain, MD; Olivier Lortholary, MD; Elie Fadel, MD

doi:10.1097/TXD.0000000000001128

Transplantation Direct (Mar 2021)

Risk of Lung Allograft Dysfunction Associated With Aspergillus Infection

Jérôme Le Pavec, MD,
Pauline Pradère, MD,
Anne Gigandon, MD,
Gaëlle Dauriat, MD,
Amélie Dureault, MD,
Claire Aguilar, MD,
Benoît Henry, MD,
Fanny Lanternier, MD,
Laurent Savale, MD,,
Samuel Dolidon, MD,
Pierre Gazengel, MD,
Sacha Mussot, MD,
Olaf Mercier, MD,
Shahid Husain, MD,
Olivier Lortholary, MD,
Elie Fadel, MD

Affiliations

Jérôme Le Pavec, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Pauline Pradère, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Anne Gigandon, MD: 4 Service de microbiologie, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
Gaëlle Dauriat, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Amélie Dureault, MD: 5 Molecular Mycology Unit, UMR2000, CNRS, Institut Pasteur, Paris, France.
Claire Aguilar, MD: 5 Molecular Mycology Unit, UMR2000, CNRS, Institut Pasteur, Paris, France.
Benoît Henry, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Fanny Lanternier, MD: 5 Molecular Mycology Unit, UMR2000, CNRS, Institut Pasteur, Paris, France.
Laurent Savale, MD,: 2 Université Paris–Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.
Samuel Dolidon, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Pierre Gazengel, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Sacha Mussot, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Olaf Mercier, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.
Shahid Husain, MD: 8 University of Toronto, University Health Network, Toronto, ON, Canada.
Olivier Lortholary, MD: 5 Molecular Mycology Unit, UMR2000, CNRS, Institut Pasteur, Paris, France.
Elie Fadel, MD: 1 Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.

DOI: https://doi.org/10.1097/TXD.0000000000001128
Journal volume & issue: Vol. 7, no. 3
p. e675

Abstract

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Background. We sought to determine whether invasive aspergillosis (IA) during the first year after lung transplantation increased the risk of chronic lung allograft dysfunction (CLAD). Methods. We retrospectively reviewed the records of 191 patients who underwent lung transplantation at our institution between January 2013 and December 2017. Screening for Aspergillus was with bronchial aspirates, bronchoalveolar lavage if indicated or during surveillance bronchoscopy, radiography, and computed tomography. We used Fine and Gray multivariable regression to identify potential risk factors for CLAD. Results. During the first posttransplant year, 72 patients had at least 1 deep-airway sample positive for Aspergillus; 63 were classified as having IA and were included in the study. Median number of endoscopies per patient during the first year was 9 (range, 1–44). Median time from transplantation to first Aspergillus-positive sample was 121 d. Bronchial aspirate samples and bronchoalveolar lavage fluid were positive in 71 and 44 patients, respectively. Aspergillus fumigatus (n = 36, 50%) predominated; bacterial samples were also positive in 22 (31%) patients. IA within 4 mo after transplantation was independently associated with CLAD development (subdistribution hazard ratio, 3.75; 95% confidence interval [CI], 1.61-8.73; P < 0.01) by regression analysis. Survival at 3 and 5 y conditional on 1-y CLAD-free survival was 37% (95% CI, 24%-58%), and 24% (95% CI, 11%-52%) in the IA <4 mo group compared to 65% (95% CI, 57%-73%) and 54% (95% CI, 43%-66%) in the non-IA group and to 69% (95% CI, 58%-83%) and 54% (95% CI, 35%-82%) in the IA ≥4 mo group, respectively (P < 0.01, logrank test). Conclusions. Our evaluation of de novo IA showed that this infection was most strongly associated with CLAD when found within 4 mo after transplantation.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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