Invasive tracheobroncial aspergillosis in donation after citizen's death for lung transplantation:a series of 20 cases
10.3760/cma.j.issn.0254-1785.2017.08.003
- VernacularTitle:肺移植术后侵袭性支气管曲霉病20例临床分析
- Author:
Hang YANG
1
;
Bo WU
;
Jingyu CHEN
;
Dong WEI
;
Ji ZHANG
;
Li FAN
;
Dong LIU
Author Information
1. 南京医科大学附属无锡市人民医院移植中心
- Keywords:
Lung transplantation;
Tracheobronchial;
Aspergillosis;
Bronchoscopy
- From:
Chinese Journal of Organ Transplantation
2017;38(8):459-463
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate clinical features and therapeutic strategies of invasive tracheobroncial aspergillosis (ITBA) in donation after citizen's death (DCD) for lung transplantation.Methods From January 2015 to June 2016,137 patients underwent lung transplantation from DCD donors.The clinical data were reviewed retrospectively.The diagnosis of ITBA was made by typical bronchoscopy findings,bronchial biopsy or bronchoalveolar lavage fluid glactomannan test.Results Twenty cases (14.60％) were diagnosed as having ITBA.The time for diagnosis of ITBA was (22.45 ± 17.70) days (7-70 days) posttransplant.Aspergillus fumigatus was the most common pathogen (n =19).The risk factors of ITBA included immunosuppressive agents (n =20),hypoproteinemia (n =6),basiliximab (n =3),preoperative aspergillus colonization (n =3),neutropenia (n.=1),aspergillus infection of the sinus (n =1).Therapeutic strategies included intravenous caspofungin,micafungin,voriconazole,posaconazole,amphotericin B,nebulized amphotericin B or amphotericin B liposome,gargled mycostatin,combined with interventional bronchoscopy.Five cases developed anastomotic or airway stenosis,one of them died,and two died due to non ITBA factors.The rest 17 cases recovered after treatment.No patient suffered from severe complications including anastomotic dehiscence,anastomotic fistula and invasive pulmonary fungal disease.Conclusion Bronchoscopy is the most important diagnostic method for ITBA.Bronchoalveolar lavage fluid glactomannan test helps to guide diagnosis.Safety needs to be taken into account in antifungal prophylaxis.Balloon dilatation should not be conducted prematurely as one important method of interventional bronchoscopy.
