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Published on: August 15, 2022
Increased mortality after pulmonary fungal infection within the first year after pediatric lung transplantation
Lara A Danziger-Isakov1, Sarah Worley, Susana Arrigain
1Department of Pediatric Infectious Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA. danzigl@ccf.org
Insights
Pulmonary fungal infections (PFIs) after pediatric lung transplant are linked to specific risk factors and significantly decrease survival. Identifying these factors is crucial for improving outcomes in lung transplant recipients.
Area of Science:
- Pediatric critical care medicine
- Transplant immunology
- Infectious diseases
Background:
- Pulmonary fungal infections (PFIs) are a significant concern following pediatric lung transplantation.
- Limited data exists on the risk factors, morbidity, and mortality associated with PFIs in the first year post-transplant.
Purpose of the Study:
- To characterize the risk factors, morbidity, and mortality of pulmonary fungal infections (PFIs) within the first year after pediatric lung transplantation.
Main Methods:
- A retrospective, multicenter study analyzed data from 555 pediatric lung transplant recipients (1988-2005).
- Statistical analyses included log-rank tests and Cox proportional hazards models to assess PFI associations with survival and risk factors.
Main Results:
- 10.5% of recipients developed PFIs within the first year post-transplant.
- Risk factors for PFI included pre-transplant colonization, cytomegalovirus (CMV) mismatch, tacrolimus-based immunosuppression, age over 15, and Grade A2 rejection.
- PFIs were independently associated with decreased 12-month survival (HR 3.9).
Conclusions:
- Key risk factors for PFIs in pediatric lung transplant recipients include rejection (Grade A2, repeated acute), CMV-positive donor status, tacrolimus-based regimens, and pre-transplant colonization.
- PFIs significantly impact survival in the first year post-transplant.
Background:
Risk factors, morbidity and mortality from pulmonary fungal infections (PFIs) within the first year after pediatric lung transplant have not previously been characterized.
Methods:
A retrospective, multicenter study from 1988 to 2005 was conducted with institutional approval from the 12 participating centers in North America and Europe. Data were recorded for the first post-transplant year. The log-rank test assessed for the association between PFI and survival. Associations between time to PFI and risk factors were assessed by Cox proportional hazards models.
Results:
Of the 555 subjects transplanted, 58 (10.5%) had 62 proven (Candida, Aspergillus or other) or probable (Aspergillus or other) PFIs within the first year post-transplant. The mean age for PFI subjects was 14.0 years vs 11.4 years for non-PFI subjects (p < 0.01). Candida and Aspergillus species were recovered equally for proven disease. Comparing subjects with PFI (n = 58) vs those without (n = 404), pre-transplant colonization was associated with PFI (hazard ratio [HR] 2.0; 95% CI 0.95 to 4.3, p = 0.067). Cytomegalovirus (CMV) mismatch, tacrolimus-based regimen and age >15 years were associated with PFI (p < 0.05). PFI was associated with any prior rejection higher than Grade A2 (HR 2.1; 95% CI 1.2 to 3.6). Cystic fibrosis, induction therapy, transplant era and type of transplant were not associated with PFI. PFI was independently associated with decreased 12-month survival (HR 3.9, 95% CI 2.2 to 6.8).
Conclusions:
Risk factors for PFI include Grade A2 rejection, repeated acute rejection, CMV-positive donor, tacrolimus-based regimen and pre-transplant colonization.
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