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Multicenter Study
. 2013 Apr;13(4):919-927.
doi: 10.1111/ajt.12131. Epub 2013 Feb 7.

Colonization With Small Conidia Aspergillus Species Is Associated With Bronchiolitis Obliterans Syndrome: A Two-Center Validation Study

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Multicenter Study

Colonization With Small Conidia Aspergillus Species Is Associated With Bronchiolitis Obliterans Syndrome: A Two-Center Validation Study

S S Weigt et al. Am J Transplant. .
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Abstract

Aspergillus colonization after lung transplantation may increase the risk for bronchiolitis obliterans syndrome (BOS), a disease of small airways. We hypothesized that colonization with small conidia Aspergillus species would be associated with a greater risk of BOS, based upon an increased likelihood of deposition in small airways. We studied adult primary lung recipients from two large centers; 298 recipients at University of California, Los Angeles and 482 recipients at Duke University Medical Center. We grouped Aspergillus species by conidia diameter≤3.5 μm. We assessed the relationship of colonization with outcomes in Cox models. Pre-BOS colonization with small conidia Aspergillus species, but not large, was a risk factor for BOS (p=0.002, HR 1.44, 95% CI 1.14-1.82), along with acute rejection, single lung and Pseudomonas. Colonization with small conidia species also associated with risk of death (p=0.03, HR 1.30, 95% CI 1.03-1.64). Although other virulence traits besides conidia size may be important, we have demonstrated in two large independent cohorts that colonization with small conidia Aspergillus species increases the risk of BOS and death. Prospective evaluation of strategies to prevent Aspergillus colonization of small airways is warranted, with the goal of preserving lung allograft function as long as possible.

Figures

Figure 1
Figure 1
Derivation of the study cohorts and reasons for exclusion. PFT = pulmonary function testing.
Figure 2
Figure 2
Kaplan-Meier estimates of cumulative incidence of Aspergillus colonization with small and large conidia species by center. (A) The incidence of colonization with small conidia Aspergillus species over time was similar at both UCLA and DUMC (P = 0.49). (B) The incidence of colonization with large conidia Aspergillus species over time was greater at DUMC as compared to UCLA (P = 0.007).

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