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Early Bronchoscopy Justified In Cystic Fibrosis Lung Transplant Patients
A DGReview of :"Aspergillus infection in lung transplant recipients with cystic fibrosis: risk factors and outcomes comparison to other types of transplant recipients"
Chest
03/21/2003
By Robert Short
The risk of tracheobronchial aspergillosis for cystic fibrosis patients receiving lung transplantation justifies early surveillance bronchoscopy to detect the infection, especially in recipients with pre-transplant colonization.
This conclusion was based on a study by Dr M Helmi, from the University of Wisconsin, Madison, United States, and colleagues.
The investigators undertook a retrospective analysis of 32 consecutive lung transplant recipients with cystic fibrosis who underwent bilateral lung transplantation at the University of Wisconsin (1994 to 2000). They studied the incidence, risk factors and consequences of Aspergillus infection and compared the findings with 101 non-cystic fibrosis recipients of lung transplantation and heart-lung transplants for other transplant indications.
It was found that 53% (17/32) of the cystic-fibrosis recipients had Aspergillus fumigatus isolated from their respiratory secretions before undergoing transplantation. In 59% of the recipients with Aspergillus (10/17), the A. fumigatus was persistently found in respiratory secretions after transplantation compared with 40% (6/15) cystic-fibrosis patients who had not been colonized pre-transplant and 28% (28/101) of the non-cystic-fibrosis recipients.
Four of the preoperatively colonized cystic fibrosis recipients developed tracheobronchial aspergillosis just distal to the bronchial anastomoses. One recipient had dehiscence of the anastomosis.
The researchers said, "None of the cystic-fibrosis recipients developed disseminated aspergillosis of pneumonia. Prophylactic antifungal therapy did not prevent tracheobronchial aspirgillosis, and IV amphotericin B therapy was required to clear the infection in all four patients." They added that endobronchial debridement of necrotic tissue required in two of the four patients.
Ten percent (10) of the non-cystic-fibrosis recipients developed Aspergillus infections post-transplant, and only three patients had successful treatment and long-term survival.
Chest 2003;123:3:800-8.
"Aspergillus infection in lung transplant recipients with cystic fibrosis: risk factors and outcomes comparison to other types of transplant recipients"
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