Related Experiment Video
Updated: Jun 16, 2026
Murine Intrapulmonary Tracheal Transplantation: A Model for Investigating Obliterative Airway Disease After Lung Transplantation
Published on: November 10, 2023
Impact of mold infections in explanted lungs on outcomes of lung transplantation
Aniket Vadnerkar1, Cornelius J Clancy, Umit Celik
1Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15251, USA.
Introduction:
Little is known about the incidence or significance of mold infections in the explanted lungs of lung transplant recipients.
Method:
We reviewed the histopathology of the explanted lungs from 304 patients who underwent lung transplantation at our institution from 2005 to 2007 and received alemtuzumab induction therapy and posttransplant voriconazole prophylaxis.
Results:
Invasive mold infections were present in the explanted lungs of 5% (14 of 304) of patients, including chronic necrotizing pneumonias (n=7), mycetomas (n=4), and invasive fungal pneumonias (n=3). Only 21% (3 of 14) received immunosuppressive therapy within 1 year before lung transplantation, suggesting that lung damage itself predisposed patients to mold infections. The risk of mold infection was higher in patients with cystic fibrosis (11%, 4 of 35) than other underlying lung diseases (4%, 10 of 269). Pulmonary mold infections were not diagnosed or suspected in 57% (8 of 14) of patients. Despite secondary voriconazole prophylaxis, fungal infections developed in 43% (6 of 14) of patients with mold infections of the explanted lungs compared with 14% (42 of 290) of patients without mold infections (P=0.01). Three patients developed invasive fungal infections while on voriconazole prophylaxis and three developed fungal infections more than 8 months after the discontinuation of voriconazole. The mortality attributable to invasive fungal infections among patients with mold infections of the explanted lungs was 29% (4 of 14).
Conclusion:
Invasive mold infections in the explanted lungs are often not recognized before lung transplantation and are associated with poor outcomes.
Insights
Mold infections in explanted lungs after lung transplantation are often missed and linked to worse outcomes. Early detection and management are crucial for improving patient survival rates.
Area of Science:
- Medical Mycology
- Transplant Surgery
- Pulmonary Medicine
Background:
- Incidence and significance of mold infections in explanted lungs post-lung transplant are largely unknown.
- Lung transplant recipients often receive immunosuppressive therapy, increasing susceptibility to infections.
Purpose of the Study:
- To determine the incidence of invasive mold infections in explanted lungs from lung transplant recipients.
- To investigate the association between mold infections and patient outcomes.
Main Methods:
- Retrospective review of histopathology from 304 explanted lungs between 2005-2007.
- Analysis of patient data including induction therapy (alemtuzumab) and antifungal prophylaxis (voriconazole).
Main Results:
- Invasive mold infections identified in 5% of explanted lungs (n=14), including chronic necrotizing pneumonia, mycetomas, and invasive fungal pneumonia.
- Patients with cystic fibrosis had a higher risk (11%) compared to other underlying diseases (4%).
- Mold infections were often undiagnosed (57%) and associated with increased fungal infections (43% vs. 14%) and higher mortality (29%) despite voriconazole prophylaxis.
Conclusions:
- Invasive mold infections in explanted lungs are frequently unrecognized pre-transplant.
- These infections are linked to poor outcomes and increased mortality in lung transplant recipients.
Related Concept Videos
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:27Cryptococcal Meningitis