Fungal re-colonization in cystic fibrosis or bronchiectasis patients after lung transplantation: Incidence, time of onset and related-factors

Objectives : In cystic fibrosis (CF) patients, after lung transplantation, the infectious re-colonization remains a major problem. Whilst the outcomes of bacterial re-colonization are well investigated, fungal re-colonization outcomes remains unclear. In this study, we aimed to estimate fungal re-colonization incidence, time of onset and identify related-factors. Methods : We performed a retrospective study of all CF and bronchiectasis patients who undergone lung transplantation between 2000 and 2012 in University Hospital of Bordeaux. Univariate and multivariate analysis were performed in patients who were colonized by fungi before transplantation. Results : Fifty-four patients were included, 45 patients presented fungal colonization. The median follow-up time was 34,9 months during wich 13 patients (24 %) died. Thirty patients (66,7 %) [0,53-0,80] presented fungal re-colonization in post transplantation. Median time of onset in fungal recolonization was of 115 days. In univariate analysis fungal re-colonization was associated with bacterial re-colonization (HR = 0,41), CI 95 % [0,37-1,02] and acute rejection (HR = 0,43), CI 95 % [0,20-0,92]. In multivariate analysis, only acute reject remained associated with fungal re-colonization (HR = 0,43), CI 95 % [0,20-0,93]. Conclusion : Acute allograft rejection episode seems to delay fungal re-colonization, immunosuppressive treatement level of every patients could explain this association. BOS was not associated with fungal re-colonization but the majority of BOS preceded fungal re-colonization. Complementary studies seem necessary to specify fungal re-colonization associated factors.