Background: Despite advances in diagnostic and therapeutic tools, mortality of invasive fungal disease (IFD) in lung transplant (LT) recipients remains high. This study aimed to describe the epidemiology of IFD in LT recipients at a large academic center.
Methods: This retrospective single center cohort study included all first-time LT recipients transplanted between 2010 and 2016 at the University of Texas Southwestern Medical Center in Dallas, TX. Data mining tools were used to extract data from the electronic health record and merge it with information from the Scientific Registry of Transplant Recipients and the Social Security Death Index (Figure 1). Medical records of subjects with positive fungal serologies, cultures or histopathology were manually reviewed and presence of IFD adjudicated using standardized definitions. Multivariable analysis was conducted using Cox proportional hazard models, with input variables treated as time dependent covariates where applicable, to identify risk factors for IFD and 1-year mortality.
Results: Of 393 LT recipients that met inclusion criteria, 68 (17%) developed a proven or probable IFD with median time to onset of 110 days (IQR 46-213) (Figure 2). The most common pathogens were: Aspergillus sp. (41%), and Candida sp. (34%). The most common sites of IFD were: lower respiratory tract (38%), tracheobronchial (25%), pleural/pericardial (15%), and bloodstream (7%). In multivariable analysis, incidence of IFD was associated with male gender (p=0.02; HR=2.05, 95% CI 1.14-3.68), and prior CMV disease (p=0.003; HR=4.16, 95% CI 1.65-10.50) (Figure 3). The 12-week mortality after the first episode of IFD was 3%; IFD was not associated with 1-year mortality (p=0.51, HR=1.27, 95% CI 0.63-2.53).
Conclusion: IFD is a frequent complication after LT. Efforts to identify risk factors may help guide the development of targeted interventions to reduce the burden of IFD in this vulnerable population.
N. Barros, None
T. Liu, None
A. Wallace, None
B. Adams-Huet, None
R. W. Haley, None
R. La Hoz, None