Risk Factors of Invasive Fungal Infections in Heart and Lung Transplantation: Systematic Review and Meta-Analysis

Abstract

Invasive fungal infection (IFI) remains one of the most common complications after heart and lung transplantation, which relates to high morbidity and mortality rates. However, risk factors associated with this infection have not been well demonstrated. We performed a comprehensive search using Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews, and Cochrane central register of a controlled trial. All case-control and cohort studies evaluated the risk factors of IFI in the adult heart, and lung transplantation was screened. Two researchers reviewed, extracted, and assessed all studies independently. We pooled the estimated effect of each independent factor associated with IFI from the multivariate analysis by using the random-effect model. Seventeen studies were included in the systematic review, and nine studies are eligible for meta-analysis. Rates of IFI among all studies range from 8 to 44%. Independent risk factors of IFI in heart and lung transplantation include anti-thymocyte globulin (ATG) therapy (HR 2.87), cytomegalovirus (CMV) infection (HR 2.53), previous fungal colonization (HR 2.43), single lung transplantation (HR 1.79) and rejection (HR 1.54). Antifungal prophylaxis (HR 0.29) and antifungal pre-emptive therapy (HR 0.20) are preventive factors for IFI. CMV infection, previous fungal colonization, rejection, ATG therapy, and single lung transplantation independently increase the risk of IFI in heart and lung transplant recipients. Antifungal prophylaxis and pre-emptive treatment are both practical preventive approaches in this transplant population.