Fungal infections in lung transplantation. Incidence, risk factors and prognostic significance

Background and aim of the work : Fungal infections are frequent following l ung transplantation and are associated with high mortality and morbidity. T he study aims at 1) reporting our experience with fungal infections after l ung transplantation; 2) identifying statistically significant correlations between the occurrence of fungal infections and bacterial infections, cytom egalovirus disease, rejection and steroid therapy; 3) assessing whether the presence of fungal infection has an impact on long-term survival. Methods: 60 lung transplant recipients were studied with respect to incidence, patt ern of presentation and median time to presentation of fungal infection aft er the transplant. Correlation analysis of the variables of interest was un dertaken in 30 patients who had a minimum follow-up of 1 year following tra nsplant. Results: the prevalence of fungal infection was 44%; severe infect ions occurred in 5 patients (11%). The presence of Candida preoperatively w as not associated with an increased risk of fungal infection. In a logistic regression analysis, a significant correlation was found between the occur rence of fungal infection and the following variables: respiratory bacteria l infections (p = 0.0003), cytomegalovirus disease (p = 0.00001) and steroi d therapy (p = 0.04). No statistically significant difference was found bet ween patients who experienced a fungal infection and those who did not, eit her in univariate or multivariate survival analysis (p = 0.08). Conclusions : 1) fungal infections are frequent in lung transplant recipients and may b e severe in more than 10% of the cases; 2) the presence of fungi preoperati vely is not a contraindication to transplantation: an antifungal prophylaxi s is probably indicated in such cases postoperatively; we recommend the use of the less nephrotoxic liposomal Amphotericin B by aerosol route; 3) a, s tatistically significant association exists between fungal infections and b oth steroid therapy and CMV disease; this suggests that a similar antifunga l prophylaxis is indicated in these clinical circumstances; 4) the presence of fungal infection is not an independent prognostic factor of long-term s urvival.