Native lung aspergilloma after single lung transplantation-a case series

Pulmonary aspergilloma is a chronic fungal infection that can cause life-threatening massive hemoptysis or deteriorate into invasive fungal disease. Unilateral lung transplant recipients (LTRs) are at particular risk for developing this complication in their pathological native lung. This study aims to describe our experience with native lung aspergilloma, its management, and outcomes.

We collected a series of cases of native lung aspergilloma based on a retrospective chart review of all patients who underwent single lung transplantation (SLT) at Rabin Medical Center between November 1997 and March 2023.

In our cohort of 911 LTRs, 465 underwent SLT. The primary diagnoses were chronic obstructive pulmonary disease (COPD) in 166 patients (35%) and idiopathic interstitial pneumonia in 261 patients (56%). Five patients were identified with native lung aspergilloma, all with interstitial lung disease (ILD) as the primary diagnosis. The median time from transplantation to aspergilloma diagnosis was 45 months. Four patients received conservative treatment with antifungal therapy; three are alive with a median follow-up of 62 months, one of whom is being evaluated for surgical intervention. One patient died within 6 months, likely due to Aspergillus infection. Another patient underwent a successful pneumonectomy and survived for more than 8 years.

This case series emphasizes the importance of a high index of suspicion of aspergilloma developing in the native lung after an SLT. Although this is a significantly high-risk group due to their immunodeficiency, their overall prognosis in our study remains similar to that of non-immunocompromised patients.