Risk factors for invasive fungal infection in lung transplant recipients on universal antifungal prophylaxis

Abstract

Abstract Background Many centers use universal antifungal prophylaxis after lung transplant, but risk factors for invasive fungal infection (IFI) in this setting are poorly described. Methods This retrospective, single center, cohort study including 603 lung transplant recipients assessed risk factors for early (within 90 days of transplant) invasive candidiasis (IC) and invasive mold infection (IMI) and late (90–365 days after transplant) IMI using Cox proportional hazard regression. Results In this cohort, 159 (26.4%) patients had 182 IFIs. Growth of yeast on donor culture (Hazard Ratio (HR) 3.30, 95% Confidence Interval (CI) 1.89, 5.75) and prolonged length of stay (HR 1.02, 95% CI 1.01, 1.03) were associated with early IC risk whereas transplantation in 2016 or 2017 (HR 0.21, 95% CI 0.06, 0.70; HR 0.25, 95% CI 0.08, 0.80, respectively) and female recipient sex (HR 0.53, 95% CI 0.30, 0.93) were associated with reduced risk. Anti-mold therapy (HR 0.21, 95% CI 0.06, 0.78) was associated lower early IMI risk and female donor sex (HR 0.40, 95% CI 0.22, 0.72) was associated with lower late IMI risk. Recent rejection was a risk factor for late IMI (HR 1.73, 95% CI 1.02, 2.95) and renal replacement therapy predisposed to early IC, early IMI, and late IMI (HR 5.67, 95% CI 3.01, 10.67; HR 7.54, 95% CI 1.93, 29.45; HR 5.33, 95% CI 1.46, 19.49, respectively). Conclusion In lung transplant recipients receiving universal antifungal prophylaxis, risk factors for early IC, early IMI, and late IMI differ.