Work

One-year clinical, radiological, and functional outcomes following antifungal therapy for aspergillus infection in lung transplant recipients

Year: 2026

Type: article

Abstract: Background Aspergillus is the most frequent fungal pathogen after lung transplantation, ranging from asymptomatic colonization to invasive disease. Treatment outcomes of aspergillosis in real-life settings remain insufficiently characterized because of the complexity and heterogeneity of its clinical presentations. Methods We conducted a retrospective study of all adult lung transplant recipients followed at Toulouse University Hospital from 2014 to 2024. Patients were stratified as Aspergillus -free, colonized, or treated for pulmonary aspergillosis (PA). Clinical, radiological, microbiological, functional, and survival outcomes were assessed in PA group. Results Among 174 patients, 46% were Aspergillus -free, 30% colonized, and 24% treated for pulmonary aspergillosis. The overall isolation rate was 54%, predominantly A. fumigatus (60%), with Aspergillus bronchitis as the most frequent form (57%). At diagnosis, 86% of treated patients were symptomatic, mainly with dyspnea (60%) and cough (48%). First-line therapy, most commonly voriconazole or isavuconazole combined with inhaled liposomal amphotericin B, required second-line adjustment in 62% of cases. At 12 months, 60% showed clinical and 67% radiological improvement, with significant gains in FVC and FEV₁ at 6 months (p = 0.0067), maintained at 12 months. Overall survival did not differ significantly between groups (p = 0.33), and five-year survival reached 80%, exceeding historical data. Conclusion In our cohort, patients treated for Aspergillus infection after lung transplantation had survival outcomes comparable to those with colonization or without Aspergillus . Despite heterogeneity in treatment approaches, proactive antifungal therapy was associated with clinical, functional, and radiological improvements, supporting early and individualized treatment strategies.

Source: JHLT Open

DOI: 10.1016/j.jhlto.2026.100525