ASPERGILLUS INFECTION IN SINGLE AND DOUBLE-LUNG TRANSPLANT RECIPIENTS

To investigate the clinical manifestations of Aspergillus infections i n lung transplant recipients, we reviewed the mycology and autopsy rep orts of all double (DLT=93) and single (SLT=48) lung transplant recipi ents from November 1983 to May 1993. Positive Aspergillus cultures wer e identified in 22% of the recipients (DLT=21, SLT=10). Colonization a lone was present in 19 recipients (DLT=16, SLT=3). Complicated Aspergi llus infection included Aspergillus bronchitis (DLT=1, SLT=1), aspergi lloma (SLT=2), pulmonary invasive aspergillosis (DLT=1, SLT=2), dissem inated aspergillosis (DLT=1, SLT=2), empyema (DLT=1), and a retroperit oneal abscess (DLT=1). Symptoms were seen only in patients with compli cated lung infections and CXR abnormalities began in the native lung o f four SLT recipients. Twenty patients survived (DLT=17, SLT=3) and 11 died (DLT=4, SLT=7) of disseminated aspergillosis (SLT=2), pulmonary invasive disease (DLT=1), bronchiolitis obliterans (DLT=2, SLT=2, CMV pneumonitis (SLT=1), diffuse alveolar damage (SLT=2), and hyperacute r ejection (DLT=1). Complicated infection and mortality were more common in SLTs than DLTs (P<0.05). We conclude that infection with Aspergill us is not infrequent in the lung transplantation population. Single lu ng recipients develop more complicated in infection than double lung r ecipients after Aspergillus infection, with native lung being a potent ial source of infection.