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Chest. 2000 Aug;118(2):403-7.

Aspergillus and endobronchial abnormalities in lung transplant recipients.

Author information

1
Inova Transplant Center, Inova Fairfax Hospital, Falls Church, VA 22042-3300, USA. steven.nathan@inova.com

Abstract

STUDY OBJECTIVE:

To determine the relationship between aspergillus recovery from the airways of lung transplant recipients and the development of endobronchial abnormalities.

DESIGN:

Retrospective case series.

SETTING:

Tertiary-care hospital.

PATIENTS:

All patients who underwent lung transplantation between December 1991 and June 1999.

MEASUREMENTS AND RESULTS:

The study cohort included 38 patients. The primary end point was the bronchoscopic identification of an endobronchial abnormality. Aspergillus was isolated from the lungs of nine patients (23.7%). Most of these isolates occurred early after transplantation (mean, 8 weeks). Endobronchial abnormalities arose in seven of the patients (18.4%) and manifested as either exuberant granulation tissue or stricture formation. Six of the 9 (66.6%) patients with aspergillus developed airway lesions, compared to 1 of the 29 patients (3.4%) without aspergillus (p = 0.0002). Endobronchial abnormalities were 19.3 times more likely to occur in patients in whom aspergillus had previously been isolated. As a screening test for the subsequent diagnosis of an airway complication, the recovery of aspergillus had a sensitivity and specificity of 85.7% and 90.3%, respectively. These aspergillus-related endobronchial abnormalities were clinically relevant as evidenced by a mean increase of 25.9% in the FEV(1) after bronchoscopic intervention.

CONCLUSION:

The early isolation of aspergillus from the airways of lung transplant recipients identifies patients at increased risk for the development of clinically significant endobronchial abnormalities.

PMID:
10936132
[Indexed for MEDLINE]
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