Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Invasive fungal infections (IFI) remain a significant cause of mortality among lung transplant recipients (LTR). The emergence of non-Aspergillus molds has become a concern in LTR receiving prophylaxis with agents active against Aspergillus.
*Methods: Single center retrospective study of non-Aspergillus mold isolation in LTR transplanted from 2012-2017. Our LTRs receive universal prophylaxis with systemic mold-active triazole for 18 months and initial aerosolized amphotericin B (AmB). Proven and probable IFI were defined by criteria established by the International Society for Heart and Lung Transplantation.
*Results: 523 LTR were followed for a median of 838 days (IQR 528 – 1356). Post-transplant, 33 non-Aspergillus molds were isolated (32 in BAL and 1 from subcutaneous tissue). 28 (5.4%) LTR had at least 1 positive culture in BAL. 1 LTR had a positive culture from subcutaneous tissue only. Talaromyces non-marneffei spp was most common (6), followed by Fusarium (4), Purpureocillium lilacinum (4), Paecylomyces variotti (3), Ochroconis gallopavum (3), Alternaria (3), Scedosporium apiospermun (2), Zygomycetes (2), Scopularopsis brevicalis (2) and others (6). Median time to first isolate was 202 days (IQR 115-354). 25/28 (89%) LTR met criteria for colonization. 19/25 (76%) were receiving itraconazole prophylaxis; 5 (20%) another mold-active triazole and 1 (4%) was on weekly AmB. Antifungal regimen was changed to targeted therapy in only 20% of cases meeting criteria for colonization. 5 (0.9%) LTR met criteria for IFI (2 proven, 3 probable), with a 1-year cumulative incidence of 0.76%. Fungal pneumonia was the most common presentation (3), followed by disseminated infection (1) and soft tissue (1). Pathogens were: Rhizopus, P. lilacinum, S. apiospermum, Alternaria, and O. gallopavum. 4/5 (80%) occurred on subtherapeutic itraconazole and 1 (disseminated Rhizopus) occurred despite of therapeutic posaconazole. No significant association was found between post-transplant colonization and development of IFI (p=0.23). Only 1 LTR with post-transplant colonization developed subsequent IFI (attack rate: 4%). 1-year all-cause mortality after IFI was 40%; with 1 death attributed to IFI (S. apiospermum pneumonia).
*Conclusions: Non-Aspergillus molds were isolated in >5% of LTR. Unlike Aspergillus, post-transplant isolation of non-Aspergillus molds was not associated with development of IFI regardless of whether or not antifungal prophylaxis was unchanged, or switched to targeted treatment. Preemptive treatment does not seem needed.
To cite this abstract in AMA style:Morillas JA, Canosa FJMarco, Hassouna H, Brizendine K. Epidemiology of Non-Aspergillus Mold in Lung Transplant Recipients at a Large Transplant Center [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/epidemiology-of-non-aspergillus-mold-in-lung-transplant-recipients-at-a-large-transplant-center/. Accessed October 24, 2020.
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