Donor and Peri-Transplant Hospitalization Risk Factors for Invasive Fungal Infection in Lung Transplant Recipients

Abstract

<h3>Purpose</h3> Invasive fungal infections (IFIs) remain a frequent complication in the lung transplant (LTx) population even in the current era of antifungal prophylaxis. The organ donor and peri-transplant period risk factors for IFI remain ill-defined. Our study goal is to identify novel risk factors for IFI, focusing on the organ donor and the recipient's transplant hospitalization. <h3>Methods</h3> We performed a single-center, case-control study. The source cohort included all adults who underwent LTx between 1/1/12-3/31/17. The primary outcome was a Probable or Proven IFI within 6 months of transplantation, as defined by EORTC/MSG criteria. Multivariable logistic regression and Cox proportional hazard regression analyses were used to identify independent risk factors for IFI. <h3>Results</h3> Of 329 LTx recipients, 45 (14%) developed IFI. The median time to IFI was 50 days (IQR: 25-110) after transplantation. Independent risk factors for IFI included: donor steroid pre-conditioning (aOR 2.24, 95%CI: 1.05-4.77, p=0.04); cardiopulmonary bypass (aOR 3.07, 95%CI: 1.06-8.87, p=0.04); ICU length of stay >30 days (aOR 3.34, 95%CI: 1.48-75, p<0.01); and bronchial anastomotic dehiscence (aOR 14.06, 95%CI: 1.99-99.34, p=0.01). Mold isolated on donor respiratory culture increased the hazard of IFI in LTx recipients (Table 1). Peri-transplant hospitalization complications that increased the hazard of IFI included: multiple positive fungal cultures, airway ischemia, and prolonged ICU stay (Table 1). Fungal treatment for ≥90 days after transplant was protective against development of IFI (Table 1). <h3>Conclusion</h3> IFI was common in our LTx cohort. Certain donor characteristics and peri-transplant complications increased the likelihood of IFI. Interventional studies, targeting the modifiable risk factors identified in this study, are needed to reduce IFI risk in LTx recipients.