Background: Lung transplant recipients are a high-risk population for invasive Aspergillus infections. We analysed prevalence, clinical presentation, treatment options and outcome of invasive Aspergillus infections in our population of patients submitted to lung transplantation. Methods. From September 1993 to December 2000,71 patients with end-stage lung disease received lung transplantation. Invasive Aspergillus infections include invasive aspergillosis and the disseminated form. Results. All invasive infections occurred in the first 6 months post-transplantation, and in some cases in association with periods of refurbishment in the vicinity of our Department. Eight patients presented an invasive aspergillosis and 2 patients a disseminated form (overall prevalence 147.); all infections involved the transplanted lung. Symptoms included respiratory impairment and fever unresponsive to wide-spectrum antibiotics for invasive aspergillosis, and symptoms related to organ dissemination (cerebral, hepatic, cardiac, renal) for the disseminated form. Amphotericin B desoxycholate was used in the first 3 patients, replaced by liposomal Amphotericin B (LAB) in the last 7 patients (dose 1-4 mg/Kg/day i.v, mean 2.15). In 5 cases aerosolized LAB was added to i.v. route to maximize drug delivery. LAB side effects were mild and consisted of hypokaliemia (1 patient) and mild increase in creatinine levels (1 patient). All invasive aspergillosis resolved with antifungal therapy and reduction of immunosuppression. The 2 disseminated forms were both fatal. Conclusions. 1. Invasive Aspergillus infections occur frequently following lung transplantation; the transplanted lung is affected more frequently than the native one. 2. Antifungal therapy with liposomal amphotericin B is as effective as amphotericin B desoxycholate and with minimal nephrotoxicity. 3. A favourable outcome may be anticipated in invasive aspergillosis, while the disseminated form is invariably fatal.
Full conference title:
Trends in Invasive fungal Infections 6, 2001
- TIFI 6th