BACKGROUND: Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized. METHODS: A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models. RESULTS: Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8). CONCLUSIONS: Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
BACKGROUND: Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized. METHODS: A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models. RESULTS: Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8). CONCLUSIONS: Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
Authors: S A Yousem; G J Berry; P T Cagle; D Chamberlain; A N Husain; R H Hruban; A Marchevsky; N P Ohori; J Ritter; S Stewart; H D Tazelaar Journal: J Heart Lung Transplant Date: 1996-01 Impact factor: 10.247
Authors: D Metras; L Viard; B Kreitmann; A Riberi; A Pannetier-Mille; O Garbi; J Y Marti; P Geigle Journal: Eur J Cardiothorac Surg Date: 1999-04 Impact factor: 4.191
Authors: R N Husni; S M Gordon; D L Longworth; A Arroliga; P C Stillwell; R K Avery; J R Maurer; A Mehta; T Kirby Journal: Clin Infect Dis Date: 1998-03 Impact factor: 9.079
Authors: M Liu; G B Mallory; M G Schecter; S Worley; S Arrigain; J Robertson; O Elidemir; L A Danziger-Isakov Journal: Pediatr Transplant Date: 2010-03-04
Authors: Evan Ammerman; Stuart C Sweet; Matthew Fenchel; Gregory A Storch; Carol Conrad; Don Hayes; Albert Faro; Samuel Goldfarb; Ernestina Melicoff; Marc Schecter; Gary Visner; Nikki M Williams; Lara Danziger-Isakov Journal: Clin Transplant Date: 2017-09-18 Impact factor: 2.863
Authors: Michael Liu; Sarah Worley; George B Mallory; Sarah Arrigain; John Robertson; Marc G Schecter; Okan Elidemir; Lara A Danziger-Isakov Journal: J Heart Lung Transplant Date: 2009-09-26 Impact factor: 10.247
Authors: Lara A Danziger-Isakov; Sarah Worley; Marian G Michaels; Susana Arrigain; Paul Aurora; Manfred Ballmann; Debra Boyer; Carol Conrad; Irmgard Eichler; Okan Elidemir; Samuel Goldfarb; George B Mallory; Peter J Mogayzel; Daiva Parakininkas; Melinda Solomon; Gary Visner; Stuart Sweet; Albert Faro Journal: Transplantation Date: 2009-05-27 Impact factor: 4.939