Background
: Invasive fungal infection (IFI) remains a common complication after lung transplantation,
causing significant morbidity and mortality. We have attempted to quantify systematically
risk factors of IFI in lung transplant recipients.
Methods
: Studies were retrieved from Ovid MEDLINE, Ovid Embase, Cochrane database of systematic
reviews and Cochrane central register of controlled trials. All case-control and cohort
studies evaluating the risk factors of IFI in adult lung transplant recipients were
screened. Two researchers reviewed and assessed all studies independently. We pooled
the estimated effect of each factor associated with IFI by using a random effect model.
Results
: Eight studies were included in the systematic review and 5 studies were eligible
for the meta-analysis. Rates of IFI range from 8% to 33% in lung transplant recipients.
Independent risk factors for invasive aspergillosis (IA) in lung transplantation include
previous fungal colonization (odds ratio [OR] 2.44; 95% confidence interval [CI] 0.08-0.47),
cytomegalovirus infection (OR 1.96; 95% CI 1.08-3.56), and single lung transplantation
(OR 1.77; 95% CI 1.08-2.91). Pre-emptive antifungal therapy is a protective factor
for IA in lung transplant (OR 0.2; 95% CI 0.08-0.47).
Conclusion
: Cytomegalovirus infection, previous fungal colonization and single lung transplantation
independently increase the risk of IA in lung transplant recipients. Pre-emptive antifungal
therapy is a protective factor for IA in the lung transplant population.
Keywords
Abbreviations:
CMV (Cytomegalovirus), COPD (Chronic obstructive disease), EORTC/MSG (European Organization for Research and Treatment of Cancer/Mycoses Study Group), GRADE (Grading of Recommendations Assessment, Development and Evaluation), IA (Invasive aspergillosis), IFI (Invasive fungal infection), ISHLT (International Society of Heart and Lung Transplantation), LTRs (Lung transplant recipients), QUIPS (Quality in Prognosis Study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 03, 2021
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© Published by Elsevier Inc. on behalf of International Society for Heart and Lung Transplantation.
