The impact of invasive fungal diseases on survival after lung transplantation

Supha K. Arthurs, Albert J. Eid, Paul J. Deziel, William F. Marshall, Stephen D. Cassivi, Randall C. Walker, Raymund R Razonable

Research output: Contribution to journalArticle

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Abstract

Recipients of lung transplants are at high risk of infectious complications. We investigated the epidemiology of infections after lung transplantation and determined their impact on survival. Methods: We retrospectively reviewed the medical records of patients who underwent lung transplantation at Mayo Clinic (Rochester) during 1990-2005. Survival analyses were performed using Kaplan-Meier estimation and Cox proportional hazard modeling. Results: Sixty-nine lung transplants were performed during the 16-yr study period. The mean (±SD) patient age was 50.5 ± 9.7 yr; 45% were male. During the mean (±SD) follow-up period of 1188 (±1288) d, the cumulative percentage of patients with infections were: bacteria (52%), cytomegalovirus (CMV) (49%), other viruses (32%), fungi (19%), mycobacteria (7%), and Pneumocystis jiroveci (1%). The median survival time after lung transplantation was 5.02 yr. Kaplan-Meier estimation of one-, three-, and five-yr survival was 80%, 61%, and 50%, respectively. Overall, 37 (54%) patients died due to graft rejection and failure (35%), invasive fungal diseases (16%), post-transplant lymphoproliferative disorder and other malignancies (14%), cardiovascular diseases (5%), CMV disease (3%), bacterial infection (3%), or other causes (24%). Survival analysis using Kaplan-Meier estimation showed that invasive fungal disease (Aspergillus sp., n = 9, Candida sp., n = 2, Alternaria sp., n = 1, Rhizopus sp., n = 1, and/or Mucor sp., n = 1) was significantly associated with mortality (p = 0.0104). After adjusting for age and graft rejection, invasive fungal disease remains a significant predictor of mortality (p = 0.0262). Conclusion: Invasive fungal disease is significantly associated with all-cause mortality after lung transplantation. An aggressive antifungal preventive strategy may lead to improved survival after lung transplantation.

Original languageEnglish (US)
Pages (from-to)341-348
Number of pages8
JournalClinical Transplantation
Volume24
Issue number3
DOIs
StatePublished - May 2010

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Lung Transplantation
Mycoses
Survival
Graft Rejection
Survival Analysis
Cytomegalovirus
Mortality
Transplants
Mucor
Pneumocystis carinii
Rhizopus
Alternaria
Lung
Lymphoproliferative Disorders
Aspergillus
Mycobacterium
Infection
Candida
Bacterial Infections
Medical Records

Keywords

  • Aspergillosis
  • Cytomegalovirus
  • Fungemia
  • Infection
  • Lung transplantation
  • Mycoses
  • Survival

ASJC Scopus subject areas

  • Transplantation

Cite this

Arthurs, S. K., Eid, A. J., Deziel, P. J., Marshall, W. F., Cassivi, S. D., Walker, R. C., & Razonable, R. R. (2010). The impact of invasive fungal diseases on survival after lung transplantation. Clinical Transplantation, 24(3), 341-348. https://doi.org/10.1111/j.1399-0012.2009.01076.x

The impact of invasive fungal diseases on survival after lung transplantation. / Arthurs, Supha K.; Eid, Albert J.; Deziel, Paul J.; Marshall, William F.; Cassivi, Stephen D.; Walker, Randall C.; Razonable, Raymund R.

In: Clinical Transplantation, Vol. 24, No. 3, 05.2010, p. 341-348.

Research output: Contribution to journalArticle

Arthurs, SK, Eid, AJ, Deziel, PJ, Marshall, WF, Cassivi, SD, Walker, RC & Razonable, RR 2010, 'The impact of invasive fungal diseases on survival after lung transplantation', Clinical Transplantation, vol. 24, no. 3, pp. 341-348. https://doi.org/10.1111/j.1399-0012.2009.01076.x
Arthurs SK, Eid AJ, Deziel PJ, Marshall WF, Cassivi SD, Walker RC et al. The impact of invasive fungal diseases on survival after lung transplantation. Clinical Transplantation. 2010 May;24(3):341-348. https://doi.org/10.1111/j.1399-0012.2009.01076.x
Arthurs, Supha K. ; Eid, Albert J. ; Deziel, Paul J. ; Marshall, William F. ; Cassivi, Stephen D. ; Walker, Randall C. ; Razonable, Raymund R. / The impact of invasive fungal diseases on survival after lung transplantation. In: Clinical Transplantation. 2010 ; Vol. 24, No. 3. pp. 341-348.
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