Objective: Lung transplant (LT) recipients are at high risk of invasive fungal infections (IFI) with an estimated 1-year incidence of 8%. Despite advances in antifungal therapy, IFIs are frequently fatal among LT recipients. Thus there is a need to identify modifiable risk factors for IFI to identify patents who may benefit from novel preventative interventions. Our study examined the risk factors for IFI among LT recipients.

Methods: A case-control study was performed at the Hospital of the University of Pennsylvania (HUP). All patients who underwent LT between 1/1/02 and 3/31/17 were included. Case patients were those with a proven or probable IFI within 180 days of LT, defined by a modified European Organisation for Research and Treatment of Cancer (EORTC) definition. Control patients were those who did not develop an IFI. Multivariable logistic regression analyses were performed.

Results: A total of 329 patients underwent LT at HUP during the study period. Fifty (15.2%) developed a proven or probable IFI within 180 days of transplant. Among the entire cohort, the median age was 60, and 142 (43%) were women. 118 (36%) underwent single LT and 211 (64%) underwent bilateral LT. The most common indications for transplant were idiopathic pulmonary fibrosis (IPF) (31%), chronic obstructive pulmonary disease (26%), and non-IPF interstitial lung disease (17%). 138 (42%) received induction immunosuppression, with the majority receiving basiliximab. The median time in the ICU post-operatively was 5.9 days (interquartile range [IQR] 2.8-12.1) with a median of 42.8 hours of ventilator time. Among the donors, 23% were classified as Public Health Service (PHS)-increased risk, and 62% received steroid pre-conditioning. Significant independent risk factors for IFI: ICU days post-operatively (adjusted odds ratio [aOR] 1.02, 95% CI 1.01-1.004, P 0.005) and steroid pre-conditioning among donors (aOR 2.11, 95% CI 1.02-4.40, P 0.045). There was a trend toward a significant association between IFI and donor cultures that grew a non-yeast fungus (aOR 2.72, P 0.137) and lower recipient BMI (aOR 0.945, P 0.117).

Conclusions: IFIs were common in our LT recipients, especially among those with greater ICU exposure. Our study suggests that donor factors, especially steroid preconditioning, may increase the risk of IFI. Further investigation is warranted to clarify the impact of donor management on IFI.

CITATION INFORMATION: Whitaker K., Anesi J., Blumberg E., Gardo L., Lee J., Crespo M., Bermudez C., Glaser L., Wilck M. Risk Factors for Invasive Fungal Infections among Lung Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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