Study objective: To determine the relationship between
aspergillus recovery from the airways of lung transplant recipients and
the development of endobronchial abnormalities.
Design: Retrospective case series.
Setting: Tertiary-care hospital.
All patients who underwent lung transplantation between December 1991
and June 1999.
Measurements and results: The study
cohort included 38 patients. The primary end point was the
bronchoscopic identification of an endobronchial abnormality.
Aspergillus was isolated from the lungs of nine patients (23.7%). Most
of these isolates occurred early after transplantation (mean, 8 weeks).
Endobronchial abnormalities arose in seven of the patients (18.4%) and
manifested as either exuberant granulation tissue or stricture
formation. Six of the 9 (66.6%) patients with aspergillus developed
airway lesions, compared to 1 of the 29 patients (3.4%) without
aspergillus (p = 0.0002). Endobronchial abnormalities were 19.3 times
more likely to occur in patients in whom aspergillus had previously
been isolated. As a screening test for the subsequent diagnosis of an
airway complication, the recovery of aspergillus had a sensitivity and
specificity of 85.7% and 90.3%, respectively. These
aspergillus-related endobronchial abnormalities were clinically
relevant as evidenced by a mean increase of 25.9% in the
FEV1 after bronchoscopic intervention.
Conclusion: The early isolation of aspergillus from
the airways of lung transplant recipients identifies patients at
increased risk for the development of clinically significant