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Author Spotlight: Investigating the Key Factors of Obliterative Bronchiolitis After Lung Transplantation
Published on: November 10, 2023
[Mold infections in lung transplants]
1Unidad de Trasplante Pulmonar, Hospital Universitario La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España.
Abstract:
Invasive infections by molds, mainly Aspergillus infections, account for more than 10% of infectious complications in lung transplant recipients. These infections have a bimodal presentation: an early one, mainly invading bronchial airways, and a late one, mostly focused on lung or disseminated. The Aspergillus colonization at any time in the post-transplant period is one of the major risk factors. Late colonization, together with chronic rejection, is one of the main causes of late invasive forms. A galactomannan value of 0.5 in bronchoalveolar lavage is currently considered a predictive factor of pulmonary invasive infection. There is no universal strategy in terms of prophylaxis. Targeted prophylaxis and preemptive treatment instead of universal prophylaxis, are gaining more followers. The therapeutic drug monitoring level of azoles is highly recommended in the treatment. Monotherapy with voriconazole is the treatment of choice in invasive aspergillosis; combined antifungal therapies are only recommended in severe, disseminated, and other infections due to non-Aspergillus molds.
Insights
Aspergillus infections are a major risk in lung transplant recipients, presenting early or late. Early detection and targeted prophylaxis are key for managing these invasive mold infections.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Pulmonology
Background:
- Invasive mold infections, primarily Aspergillus, complicate over 10% of lung transplant cases.
- These infections exhibit bimodal presentation: early (airway) and late (lung/disseminated).
- Aspergillus colonization and chronic rejection are significant risk factors for invasive disease.
Purpose of the Study:
- To review the epidemiology, risk factors, diagnosis, and management of invasive Aspergillus infections in lung transplant recipients.
- To discuss current prophylaxis strategies and diagnostic markers.
- To outline recommended treatment approaches for invasive aspergillosis.
Main Methods:
- Literature review of invasive mold infections in lung transplantation.
- Analysis of diagnostic criteria, including galactomannan levels.
- Evaluation of prophylaxis and treatment strategies.
Main Results:
- A galactomannan level of 0.5 in bronchoalveolar lavage is a predictive factor for invasive pulmonary infection.
- Targeted prophylaxis and preemptive treatment are increasingly favored over universal prophylaxis.
- Voriconazole monotherapy is the preferred treatment for invasive aspergillosis.
Conclusions:
- Invasive Aspergillus infections pose a significant threat to lung transplant recipients.
- Early detection and risk factor management are crucial.
- Personalized prophylaxis and treatment strategies, including therapeutic drug monitoring, improve outcomes.
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