BACKGROUND: Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking. METHODS: NIH-sponsored Clinical Trials in Organ Transplantation in Children enrolled PLT candidates, collecting data prospectively for 2 years post-transplant. Demographics, signs/symptoms, radiology, pathology and microbiology were collected. Analyses evaluated for PFI-related risks and outcomes. RESULTS: In 59 PLT, pre-transplant fungal colonization occurred in 6 donors and 15 recipients. Cystic fibrosis (CF) was associated with pre-transplant colonization (P < .01). Twenty-five (42%) PLT had 26 post-transplant colonizations (median = 67 days, range = 0-750 days) with Candida (13), Aspergillus (4), mold (6) or yeast (3). Post-PLT colonization was not associated with CF, age, or pre-PLT colonization. Thirteen PFIs occurred in 10 (17%) patients, 3 proven (Candida species) and 10 probable (Candida [3], Aspergillus [3], Penicillium [3], and mold [1]). Pulmonary fungal infection was preceded by post-PLT colonization with the same organism in 4 of 13 PFI, but post-PLT colonization did not predict subsequent PFI (P = .87). Older age at transplant was a risk for PFI (P < .01). No mortality was attributed to PFI. Prophylaxis use was not associated with decreased post-PLT colonization (P = .60) or PFI (P = .48). CONCLUSION: In PLT, PFI and fungal colonization are common but without associated mortality. Post-PLT colonization did not predict PFI. Optimal prevention strategies require additional study.
BACKGROUND: Prospective studies to determine associated risk factors and related outcomes for pulmonary fungal infection (PFI) after pediatric lung transplant (PLT) are lacking. METHODS: NIH-sponsored Clinical Trials in Organ Transplantation in Children enrolled PLT candidates, collecting data prospectively for 2 years post-transplant. Demographics, signs/symptoms, radiology, pathology and microbiology were collected. Analyses evaluated for PFI-related risks and outcomes. RESULTS: In 59 PLT, pre-transplant fungal colonization occurred in 6 donors and 15 recipients. Cystic fibrosis (CF) was associated with pre-transplant colonization (P < .01). Twenty-five (42%) PLT had 26 post-transplant colonizations (median = 67 days, range = 0-750 days) with Candida (13), Aspergillus (4), mold (6) or yeast (3). Post-PLT colonization was not associated with CF, age, or pre-PLT colonization. Thirteen PFIs occurred in 10 (17%) patients, 3 proven (Candida species) and 10 probable (Candida [3], Aspergillus [3], Penicillium [3], and mold [1]). Pulmonary fungal infection was preceded by post-PLT colonization with the same organism in 4 of 13 PFI, but post-PLT colonization did not predict subsequent PFI (P = .87). Older age at transplant was a risk for PFI (P < .01). No mortality was attributed to PFI. Prophylaxis use was not associated with decreased post-PLT colonization (P = .60) or PFI (P = .48). CONCLUSION: In PLT, PFI and fungal colonization are common but without associated mortality. Post-PLT colonization did not predict PFI. Optimal prevention strategies require additional study.
Authors: Shahid Husain; Amparo Sole; Barbara D Alexander; Saima Aslam; Robin Avery; Christian Benden; Eliane M Billaud; Daniel Chambers; Lara Danziger-Isakov; Savitri Fedson; Kate Gould; Aric Gregson; Paolo Grossi; Denis Hadjiliadis; Peter Hopkins; Me-Linh Luong; Debbie J E Marriott; Victor Monforte; Patricia Muñoz; Alessandro C Pasqualotto; Antonio Roman; Fernanda P Silveira; Jeffrey Teuteberg; Stephen Weigt; Aimee K Zaas; Andreas Zuckerman; Orla Morrissey Journal: J Heart Lung Transplant Date: 2016-01-19 Impact factor: 10.247
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
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Authors: Shahid Husain; Martha L Mooney; Lara Danziger-Isakov; Frauke Mattner; Nina Singh; Robin Avery; Michael Ison; Atul Humar; Robert F Padera; Leo P Lawler; Andy Fisher; Richard J Drew; Kate F Gould; Amparo Sole; Sean Studer; Patricia Munoz; Lianne G Singer; Margaret Hannan Journal: J Heart Lung Transplant Date: 2011-04 Impact factor: 10.247
Authors: Stuart C Sweet; Hyunsook Chin; Carol Conrad; Don Hayes; Peter S Heeger; Albert Faro; Samuel Goldfarb; Ernestina Melicoff-Portillo; Thalachallour Mohanakumar; Jonah Odim; Marc Schecter; Gregory A Storch; Gary Visner; Nikki M Williams; Karen Kesler; Lara Danziger-Isakov Journal: Am J Transplant Date: 2019-07-25 Impact factor: 8.086