Methods: Patients who received a lung transplant in one of five transplant centers during April 2006–September 2010 were eligible for enrollment. Standardized forms were used to collect data pre-transplant, at the time of transplant, weekly for the first 12 weeks post-transplant, and then monthly for a total of 30 months post-transplant. Proven and probable IFIs during the study period were defined according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Differences in IFI timing by infection type were evaluated with the Kruskal-Wallis test. The cumulative incidence of first IFI was calculated with infection-free death treated as a competing risk. Ninety-day survival following IFI was estimated using the Kaplan-Meier method.
Results: Of 293 lung transplant patients enrolled, 24 (8.2%) developed 28 episodes of IFI caused by Aspergillus spp (n=15), Candida spp (n=7), Pneumocystis jiroveci (n=4), Cryptococcus neoformans (n=1), and Rhizopus arrhizus (n=1); all non-Candida IFI were respiratory infections. The median time to IFI was 239 days post-transplant (interquartile range [IQR] 37–384) and varied by infection type: Pneumocystis (median 672, IQR 436–805), Aspergillus (260, 78–327), Candida (83, 8–384), other pathogens (15, 12–18), P = 0.02. No patients with Pneumocystis infection were receiving prophylaxis at the time of infection. The cumulative incidence for any IFI at 6, 12, 24, and 30 months was 4.5%, 6.7%, 7.8%, and 10.5%, respectively. Overall 90-day survival following IFI was 58% (68% for aspergillosis, 40% for candidiasis, and 25% for Pneumocystis pneumonia).
Conclusion: Although <10% of patients experienced IFI, all-cause mortality following IFI was high. Our findings point out the importance of prophylaxis for Pneumocystis pneumonia beyond one year post transplant. Further analyses will assess variation in IFI timing by prophylaxis regimens and risk factors for IFI while on prophylaxis and after discontinuing prophylaxis.
R. K. Mody,
R. Avery, Astellas: Investigator , Research support
Merck: Investigator , Research support
M. Schuster, None
F. Silveira, Astellas: Investigator , Research grant
Pfizer: Investigator , Research grant
S. Hussain, Pfizer: Investigator , Research grant
Merck: Investigator , Research grant
Astellas: Investigator , Research grant
G. Derado, None
T. Chiller, None
P. Pappas, None
C. Kauffman, None
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