Article,
Non-Aspergillus Fumigatus Mold Infections (NAFMI) in Lung Transplant (LT) Recipients, Pathogens and Risk Factors
Contributors
Walti, Laura Naëmi
0000-0002-7048-6590
(Corresponding author)
[1]
Crone, Cornelia Geisler
0000-0001-7436-6695
[3]
Kothari, Sagar
0000-0002-2376-2345
[1]
Perch, Michael
0000-0001-9740-1246
[3]
Aversa, Meghan M
0000-0002-7361-0024
[6]
Keshavjee, Shafique H
0000-0003-4547-8094
[1]
Husain, Shahid
0000-0002-9216-5229
[1]
Affiliations
- [1] University Health Network [NORA names: Canada; America, North; OECD];
- [2] Assistance Publique - Hôpitaux de Paris [NORA names: France; Europe, EU; OECD];
- [3] Rigshospitalet [NORA names: Capital Region of Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD];
- [4] Hospital Universitario Reina Sofía [NORA names: Spain; Europe, EU; OECD];
- [5] Siena, Italy [NORA names: Miscellaneous; Italy; Europe, EU; OECD];
(... more)
Abstract
Purpose While Aspergillus fumigatus is the most frequent pathogen involved in invasive fungal infections (IFI) post-LT, non-Aspergillus fumigatus mold infections (NAFMI) are emerging. However, little is known about associated fungal pathogens and risk factors. Methods: We performed an international, multicenter 1 :1 Case (NAFMI)-Control (No IFI) study, matching according to center and time post-LT. NAFMI was defined according to the ISHLT criteria for IFI. We assessed fungal pathogens and evaluated risk factors for the occurrence of NAFMI using logistic regression models. Results We included 64 cases of NAFMI. Aspergillus niger and flavus were the most commonly identified pathogens (18/64; 28% and 14/64; 22%), followed by non-Aspergillus Molds (11/64; 17%) and Mucorales (1/64; 2%). Poly fungal infections consistently involved Aspergillus spp. (8/8; 100%) Figure A. Median time to NAFMI was 6 months (IQR 3, 23). In univariable analyses, pre-LT immunosuppression (OR 5.28 p<0.001), pre-LT diabetes (OR 3.75 p=0.028), pre-LT bacterial and fungal colonization (OR 4.29 p=0.001 and OR 6.43 p=0.019), pre-LT ICU stay (OR 5.99 p=0.002), and acute rejection in preceding 3 months (OR 3.07 p=0.021) were associated with NAFMI Table B. However, age, sex, underlying disease, anti-fungal treatment within 3 months pre-LT, as well as steroid dose, neutrophil and lymphocyte count in the month preceding NAFMI were similar between cases and controls. In multivariable analysis, only pre-transplant immunosuppression (OR 3.8 95%CI 1.56-9.20, p=0.003) and ICU stay (OR 3.98 95%CI 1.04-15.24 p=0.043) were independent factors associated with NAFMI. Occurrence of death or chronic lung allograft dysfunction within 12 months after NAFMI were similar in both groups. Conclusion Aspergillus species are predominant in NAFMI in LT recipients. Pre-transplant Immunosuppression and ICU stay were significant risk factors associated with the development of NAFMI.
