Early Fungal Bronchial Colonization after Lung Transplantation: Risk Factors and Outcome

Purpose Postoperative infectious complications are key issues following lung transplantation (LT). Fungal bronchial colonization (FBC) is reported in 40 to 80% of the cases and is usually considered as a complication. The risk factors, morbidity and mortality linked to FBC were assessed in a retrospective monocentric cohort of LT. Methods and Materials From 2006 to 2010, all consecutive LT performed in our institution were included. Demographic and microbiologic data during the first 30 postoperative days after LT were collected. The risk factors of developing FBC and its prognosis were assessed. Results Among 102 LT (emphysema 46%, idiopathic fibrosis 38%), FBC was reported after LT in 52% of the cases in a median delay of 3 [2-5 IQ] days after LT. Only one donor was colonized while 11 % of the recipients were colonized before LT. The main organisms involved in FBC were Candidas (78% of the cases, C albicans (54%), other Candidas species (24%)) while Aspergillus were reported in 9% of the cases. The risk factors associated with FBC are presented in the table 1 . Ischemic bronchitis was reported in 24% of the cases and all of them developed FBC. 75% of FBC were treated by antifungal therapy. Interestingly FBC did not have any impact on length of mechanical ventilation and mortality at day 30. Conclusions FBC is a frequent situation, especially in double LT. The links between ischemic bronchitis and FBC are not clear. FBC in these cases could be a consequence rather than a cause. In patients with identified risk factors (double LT, colonization of conservation liquid), a preemptive antifungal therapy could be discussed. Factors associated with fungal colonization Parameters Odds Ratio 95% IC p Double lung transplantation 3.93 1.49-10.40 0.0037 Hospitalisation >10 days 2.75 1.12-6.77 0.0214 ischemic bronchitis 10.06 2.77-36.66 0.0001 conservation liquid colonization 8.66 0.98-76.11 0.028