Chest
Volume 118, Issue 2, August 2000, Pages 403-407
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Clinical Investigations: Lung Transplantation
Aspergillus and Endobronchial Abnormalities in Lung Transplant Recipients

https://doi.org/10.1378/chest.118.2.403Get rights and content

Study objective

To determine the relationship between aspergillus recovery from the airways of lung transplant recipients and the development of endobronchial abnormalities.

Design

Retrospective case series.

Setting

Tertiary-care hospital.

Patients

All patients who underwent lung transplantation between December 1991 and June 1999.

Measurements and results

The study cohort included 38 patients. The primary end point was the bronchoscopic identification of an endobronchial abnormality. Aspergillus was isolated from the lungs of nine patients (23.7%). Most of these isolates occurred early after transplantation (mean, 8 weeks). Endobronchial abnormalities arose in seven of the patients (18.4%) and manifested as either exuberant granulation tissue or stricture formation. Six of the 9 (66.6%) patients with aspergillus developed airway lesions, compared to 1 of the 29 patients (3.4%) without aspergillus (p = 0.0002). Endobronchial abnormalities were 19.3 times more likely to occur in patients in whom aspergillus had previously been isolated. As a screening test for the subsequent diagnosis of an airway complication, the recovery of aspergillus had a sensitivity and specificity of 85.7% and 90.3%, respectively. These aspergillus-related endobronchial abnormalities were clinically relevant as evidenced by a mean increase of 25.9% in the FEV1 after bronchoscopic intervention.

Conclusion

The early isolation of aspergillus from the airways of lung transplant recipients identifies patients at increased risk for the development of clinically significant endobronchial abnormalities.

Section snippets

Subjects

We reviewed the records of all patients who underwent lung or heart-lung transplantation at our institution between December 1991 and June 1999. This cohort included 38 patients (15 men and 23 women), with a mean ± SD age of 49.9 ± 9.9 years. In 31 cases, single lung transplantation was performed; in six instances, bilateral lung transplantation was done; and there was one heart-lung recipient. There were therefore a total of 44 anastomoses in the study group. These were performed end to end

Results

Aspergillus was isolated in a total of 9 of 38 patients (23.7%). All isolates were of the Aspergillus fumigatus subtype. Endobronchial complications were diagnosed in seven patients (18.4%). Of these, two patients developed a stricture and five patients developed EGT. A typical example of the latter is shown in Figure 1. Six of the nine patients (66.6%) from the aspergillus cohort developed airway complications, as compared to 1 of 29 patients (3.4%) in whom aspergillus was not isolated (p =

Discussion

Endobronchial narrowing resulting in flow limitation after lung transplantation mostly takes the form of stricture formation at the bronchial anastomosis. These have a reported incidence of anywhere from 0 to 15%.1234 It is believed that anastomotic problems are related to bronchial ischemia, since the bronchial circulation is sacrificed during the transplant procedure. It is unlikely that ischemia is the only factor in bronchial anastomotic problems, since the reported incidence with

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All work was performed at Inova Fairfax Hospital.

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