Risk factors and outcomes in lung transplant recipients with nodular invasive pulmonary aspergillosis

Background: Whether nodular lesions have specific risk-factors or influence outcomes in lung transplant recipients with invasive aspergillosis, is not fully known. Methods: The study population consisted of 64 consecutive lung transplant recipients with proven or probable invasive aspergillosis. Nodules, with or without halo/air crescent-sign were considered nodular presentations. Outcomes assessed were response rate (successful versus unsuccessful outcome) and all-cause mortality at 12 weeks. Results: Overall, 34 patients had nodular and 30 had non-nodular lesions. Presence of nodular lesions was less likely to be associated with renal failure at baseline (adjusted OR 0.21, 95% CI, 0.04-0.97, p=0.047), CMV infection (adjusted OR 0.18, 95% CI 0.04-0.75, p=0.019) and receipt of antifungal prophylaxis (adjusted OR 0.22, 95% CI, 0.06-0.88, p=0.032). Successful outcome and mortality rates in the study patients were 64.0% (41/64) and 25.0% (16/64), respectively. Nodular aspergillosis was associated with significantly higher successful outcome (adjusted OR 3.35, 95% CI, 1.06-10.54, p=0.039) and lower mortality at 12 weeks (adjusted OR 0.20, 0.05-0.78, p=0.021). Conclusions: Lung transplant recipients with nodular lesions due to invasive aspergillosis had better outcomes than those without such lesions.