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Clinical Investigations: TRANSPLANTS |

Saprophytic Fungal Infections and Complications Involving the Bronchial Anastomosis Following Human Lung Transplantation*

David R. Nunley, MD, FCCP; Anthony A. Gal, MD, FCCP; J. David Vega, MD; Carl Perlino, MD; Pauline Smith, RN, MSN; E. Clinton Lawrence, MD, FCCP
Author and Funding Information

*From the Departments of Internal Medicine (Drs. Nunley, Perlino, and Lawrence, and Ms. Smith), Surgery (Dr. Vega), and Pathology (Dr. Gal), Andrew J. McKelvey Lung Transplantation Center, Emory University School of Medicine, Atlanta, GA.

Correspondence to: David R. Nunley, MD, FCCP, C-605, Emory University Hospital, 1364 Clifton Rd, NE, Atlanta, GA 30322; e-mail: david–nunley@emory.org



Chest. 2002;122(4):1185-1191. doi:10.1378/chest.122.4.1185
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Published online

Study objective: To demonstrate an association between saprophytic fungal infections occurring at the bronchial anastomosis (BA) and the development of additional complications arising at this site.

Design: Retrospective review.

Setting: University lung transplant center.

Materials and methods: Review of all single-lung and double-lung transplant (LTX) recipients who underwent transplantation between June 1993 and December 2000. All recipients were subjected to surveillance bronchoscopy with biopsy at predetermined intervals and when clinically indicated. Bronchial wash fluid and biopsy material were examined using appropriate fungal stains and culture techniques. An infection was defined when fungal organisms were identified in tissue specimens.

Results: Fifteen saprophytic fungal infections involving the BA were identified in 61 LTX recipients (24.6%) who survived a minimum of 75 days post-transplantation. Infections were attributed to Aspergillus sp (n = 9), Candida sp (n = 2), Torulopsis sp (n = 1), and mixed flora (ie, Penicillium + Candida, two patients; and Aspergillus + Candida, one patient). Saprophytic fungal infections occurred by a median of postoperative day 35 (range, 13 to 159 days). Airway complications involving the BA ultimately developed in 11 of 61 recipients (18%). These complications included symptomatic bronchial stenosis (nine patients), bronchomalacia (one patient), and fatal hemorrhage (one patient). Bronchial complications arose in 7 of 15 recipients (46.7%) with saprophytic fungal infections of the BA in contrast to 4 of 46 (8.7%) without infections (p = 0.003, Fisher exact test). Also demonstrated was a positive correlation between anastomotic infections and bronchial complications (Φ coefficient = 0.43; p = 0.001), while logistic regression analysis revealed that the absence of anastomotic infections predicted the absence of such complications (p = 0.002). The risk of developing an additional complication following an anastomotic infection in patients with infections was five times that of those recipients without an infection (relative risk, 5.36; 95% confidence interval [CI], 1.82 to 15.79). The odds in favor of a bronchial complication following an infection were eight times greater than in those recipients without infection (odds ratio, 8.31; 95% CI, 1.96 to 35.16).

Conclusions: Following LTX, saprophytic fungal infections of the BA are associated with serious airway complications.

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