Unique Characteristics of Fungal Infections in Lung Transplant Recipients

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Unique susceptibility of lung transplants to infections

The two solid organs that are in direct continuity to the environment include the lung and the small intestine. Lungs are unique, however, because not only are they directly exposed to the environment but also their transplantation results in the impairment of host defenses of the organ. As a result of transplantation, denervation and impairment of lymphatic drainage ensue. These factors coupled with blunted cough reflex and defective mucociliary clearance contribute to the milieu of microbial

Aspergillus

The incidence and timing of invasive aspergillosis (IA) in lung transplant recipients has changed over time. Earlier reports had reported the incidence to be as high as 23% during the first year after transplantation.7, 8, 9 Recent data, however, suggest a much lower incidence during the first year (cumulative incidence of 2.4%).10 Thirty percent of the cases in this series occurred after 6 months. In one center, with universal azole prophylaxis, the median time to onset of IA was noted to be

Aspergillus

The true predictive value of Aspergillus colonization is hard to discern because in most case series, adequate data for prophylaxis has not been provided.5 Pretransplant colonization with Aspergillus organisms was noted in 22% to 58% of cystic fibrosis patients and in 28% of non–cystic fibrosis patients undergoing transplantation.20, 21 Of those cystic fibrosis patients who had pretransplant colonization, 25% to 42% subsequently developed Aspergillus tracheobronchitis within 6 months of

Galactomannan for the diagnosis of invasive aspergillosis in lung transplant recipients

Galactomannan is a polysaccharide cell wall component that is released by Aspergillus organisms during fungal growth. Detection of galactomannan by sandwich enzyme immunoassay is approved for use in hematopoietic stem cell transplant recipients. Few studies have evaluated the utility of galactomannan in the diagnosis of IA in lung transplants recipients. In one study of 70 lung transplant recipients that used 0.5 as a cut-off value for positive test, the sensitivity of the test in the serum was

Amphotericin and Its Lipid Preparations

The ideal prophylactic strategy would be efficacious, convenient, devoid of side effects, and cost-effective. Because Aspergillus organisms are ubiquitous in nature and are inhaled into the small airways and bronchioles, causing the disease, delivery of the drug to the respiratory system by aerosolization to prevent IA is theoretically desirable. An optimal antifungal prophylactic strategy in lung transplant recipients still remains to be determined. A wide variation in the practice of

Summary

The landscape of fungal infection in lung transplant recipients is changing. Fungal infections in lung transplant recipients exhibit unique clinical features, including colonization and tracheobronchitis that require distinct management challenges. The risk stratification and the optimal prophylactic strategy still remain to be defined. Galactomannan measurement in the BAL appears promising for the diagnosis of IA. The efficacy and long-term safety of inhaled amphotericin for prophylaxis

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