1525. Scedosporium is a Risk Factor for Bronchiolitis Obliterans Syndrome in Lung Transplantation
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: A significant factor limiting long-term survival in lung transplant recipients (LT-R) is bronchiolitis obliterans syndrome (BOS).  There is growing evidence that infections may play a role in the development of BOS.  Scedosporium is an emerging pathogen among solid organ transplant recipients. Our aim was to determine if Scedosporium respiratory colonization or invasive disease (SRCI) are risk factors for BOS and mortality.

Methods: We performed a single-center review of LT-R from February 2000 until March 2012.  All lung transplant patients who were free of BOS 90 days after transplant and received sufficient pulmonary function tests to assess for BOS were eligible for analysis. Invasive Scedosporium infection was defined as a positive culture from bronchoalveolar lavage with evidence of disease on imaging, as per modified EORTC/IFICG criteria.  Those who had positive cultures for Scedosporium without evidence for invasive infection were considered to be colonized.

Results: In 356 lung transplants performed, 258 were eligible for analysis.  Median age at transplant was 57 (interquartile range 46-63), and 84% (218/258) of patients received a bilateral lung transplant. Mean time to onset of BOS was 2.4 years.   Seven patients developed Scedosporium colonization, while 8 developed infection.  In multivariate Cox regression models that evaluated for transplant type, sex, age at transplant, induction agent, acute rejection, and Aspergillus colonization or invasive infection, SRCI was associated with increased risk for BOS (HR 6.67, 95% CI 1.83-24.29, p=0.004) and death (HR 5.37, 95% CI 2.29-12.59, p<0.0001).  This risk persisted when SRCI was considered as a time-dependent predictor in multivariable models.

Conclusion: These data suggest a potential association between SRCI and BOS, in addition to SRCI and mortality.  Strategies to prevent Scedosporium and ensure eradication may be useful in preventing allograft lung injury.

Janet Kim, MD1, John Greenland, MD2, Seth Cohen, MD3, Max Binstock, BS4, Farhaan Hafeez, BS5, Elaine Allen, PhD6, Jonathan Singer, MD2, Sarah Arron, MD, PhD5, Steven Hays, MD7, Rebecca Boettger, PharmD8, Jasleen Kukreja, MD9 and Peter Chin-Hong, MD10, (1)Infectious Diseases, UCSF, San Francisco, CA, (2)Pulmonary and Critical Care, UCSF, San Francisco, CA, (3)Medicine, University of California, San Francisco, CA, (4)Dermatology, UCSF, San Francisco, CA, (5)Dermatology, University of California, San Francisco, San Francisco, CA, (6)Epidemiology and Biostatistics, UCSF, San Francisco, CA, (7)Pulmonary and Critical Care, University of California, San Francisco, San Francisco, CA, (8)Pharmacy, UCSF, San Francisco, CA, (9)Thoracic Surgery, UCSF, San Francisco, CA, (10)Internal Medicine, Division of Infectious Disease, UCSF, San Francisco, CA

Disclosures:

J. Kim, None

J. Greenland, None

S. Cohen, None

M. Binstock, None

F. Hafeez, None

E. Allen, None

J. Singer, None

S. Arron, None

S. Hays, None

R. Boettger, None

J. Kukreja, None

P. Chin-Hong, None

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