Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Chunrong Ju; Qiaoyan Lian; Xin Xu; Qingdong Cao; Cong Lan; Rongchang Chen; Jianxing He

doi:10.3389/fmed.2021.718747

Epidemiology and Prognosis of Invasive Fungal Disease in Chinese Lung Transplant Recipients

Front Med (Lausanne). 2021 Oct 27:8:718747. doi: 10.3389/fmed.2021.718747. eCollection 2021.

Authors

Chunrong Ju¹, Qiaoyan Lian¹, Xin Xu¹, Qingdong Cao², Cong Lan³, Rongchang Chen⁴, Jianxing He¹

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Thoracic Surgery and Lung Transplantation, The Fifth Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhuhai, China.
³ Department of Thoracic Surgery, Gaozhou People's Hospital, Gaozhou, China.
⁴ Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, China.

Abstract

This study explored the epidemiology, risk factors, and prognosis of invasive fungal disease (IFD) in Chinese lung transplant recipients (LTRs). This retrospective cohort study included patients who received lung transplants at four hospitals in South China between January 2015 and June 2019. The participants were divided into IFD and non-IFD (NIFD) groups. The final analysis included 226 LTRs (83.2% males) aged 55.0 ± 14.2 years old. Eighty-two LTRs (36.3%) developed IFD (proven or probable diagnosis). The most common pathogens were Aspergillus (57.3%), Candida (19.5%), and Pneumocystis jiroveci (13.4%). Multivariate logistic regression revealed that anastomotic disease [odds ratio (OR): 11.86; 95% confidence interval (95%CI): 4.76-29.54; P < 0.001], cytomegalovirus (CMV) pneumonia (OR: 3.85; 95%CI: 1.88-7.91; P = 0.018), and pre-transplantation IFD (OR: 7.65; 95%CI: 2.55-22.96; P < 0.001) were associated with higher odds of IFD, while double-lung transplantation (OR: 0.40; 95%CI: 0.19-0.79; P = 0.009) was associated with lower odds of IFD. Logistic regression analysis showed that anastomotic disease was associated with higher odds of death (OR: 5.01; 95%CI: 1.24-20.20; P = 0.02) and that PJP prophylaxis was associated with lower odds of death (OR: 0.01; 95%CI: 0.001-0.11; P < 0.001). Invasive fungal disease is prevalent among LTRs in southern China, with Aspergillus the most common pathogen. Prophylaxis should be optimized based on likely pathogens.

Keywords: Candida; aspergillosis; invasive fungal infections; lung transplantation; prophylaxis; risk factors.