Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Abstract

This study explored the epidemiology, risk factors, and prognosis of invasive fungal disease (IFD) in Chinese lung transplant recipients (LTRs). This retrospective cohort study included patients who received lung transplants at four hospitals in South China between January 2015 and June 2019. The participants were divided into IFD and non-IFD (NIFD) groups. The final analysis included 226 LTRs (83.2% males) aged 55.0 ± 14.2 years old. Eighty-two LTRs (36.3%) developed IFD (proven or probable diagnosis). The most common pathogens were Aspergillus (57.3%), Candida (19.5%), and Pneumocystis jiroveci (13.4%). Multivariate logistic regression revealed that anastomotic disease [odds ratio (OR): 11.86; 95% confidence interval (95%CI): 4.76–29.54; P < 0.001], cytomegalovirus (CMV) pneumonia (OR: 3.85; 95%CI: 1.88–7.91; P = 0.018), and pre-transplantation IFD (OR: 7.65; 95%CI: 2.55–22.96; P < 0.001) were associated with higher odds of IFD, while double-lung transplantation (OR: 0.40; 95%CI: 0.19–0.79; P = 0.009) was associated with lower odds of IFD. Logistic regression analysis showed that anastomotic disease was associated with higher odds of death (OR: 5.01; 95%CI: 1.24–20.20; P = 0.02) and that PJP prophylaxis was associated with lower odds of death (OR: 0.01; 95%CI: 0.001–0.11; P < 0.001). Invasive fungal disease is prevalent among LTRs in southern China, with Aspergillus the most common pathogen. Prophylaxis should be optimized based on likely pathogens.

Risk Factors for Early Fungal Disease in Solid Organ Transplant Recipients: A Systematic Review and Meta-analysis

“…Chance-adjusted interrater agreement for study inclusion, determined using kappa statistic, was 0.86 (CI, 0.75-0.95; P = 0.05) indicating almost perfect agreement. Of the 58 articles included in the systematic review, 5,22-78 27 studies either initially contained or provided after email contact enough information to calculate a quantitative relationship between risk factors and IFI within the first year posttransplant. 22-42,51,69,70,74,77,78 Of the 27 studies included in the meta-analysis, 13 evaluated risk factors for any IFI, 23,24,27,28,30,33,35,36,38,41,42,77,78 10 evaluated risk factors for IA, 22,25,26,32,34,37,39,40,51,74 2 evaluated for risk factors for only IA or IC, 29,31 and 2 evaluated risk factors for IC.…”

“…Table 1 summarizes key study characteristics. Topically, 20 studies pertained to liver transplant, 27-36,52-59,77,78 15 to lung transplant, 5,38-41,64-67,69,71,72,74-76 9 to kidney transplant, 25,26,46-51,73 6 to heart transplant, 22-24,43-45 1 to small bowel transplant, 68 2 to pancreas-kidney transplant, 42,70 and 5 to multiple SOT groups. 37,60-63 One study evaluated a specific lung transplant population (those with cystic fibrosis 40 ), and 3 studies evaluated a specific liver transplant population (2 with deceased donors only 29,33 and 1 with living donors only 55 ).…”

“…Of the 19 studies that included lung transplant recipients (15 included only lung transplant and 4 included multiple SOT groups), 7 studies 5,38,41,64,66,72,75 evaluated risk factors for any IFI. Most IFI reported were either IA or IC.…”

“…Table 1 summarizes key study characteristics. Topically, 20 studies pertained to liver transplant, [27][28][29][30][31][32][33][34][35][36][52][53][54][55][56][57][58][59]77,78 15 to lung transplant, 5, [38][39][40][41][64][65][66][67]69,71,72,[74][75][76] 9 to kidney transplant, 25,26,[46][47][48][49][50][51]73 6 to heart transplant, [22][23][24][43][44][45] 1 to small bowel transplant, 68 2 to pancreas-kidney tr...…”

Efficacy of different durations of antifungal prophylaxis with nebulized amphotericin B after lung transplantation: a retrospective cohort study

“…However, post-lung transplant survival is still low compared with other solid organ transplantations, mainly due to pulmonary and airway fungal infections ( 1 , 2 ). Aspergillus is the most frequent pathogen causing invasive fungal diseases (IFDs) in Chinese lung transplant recipients ( 3 ). Universal antifungal prophylaxis is recommended by many lung transplantation guidelines and adopted by most transplant centers.…”