Risk factors of invasive fungal infections in lung transplant recipients: A systematic review and meta-analysis

Background : Invasive fungal infection (IFI) remains a common complication after lung transplantation, causing significant morbidity and mortality. We have attempted to quantify systematically risk factors of IFI in lung transplant recipients. Methods : Studies were retrieved from Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews and Cochrane central register of controlled trials. All case-control and cohort studies evaluating the risk factors of IFI in adult lung transplant recipients were screened. Two researchers reviewed and assessed all studies independently. We pooled the estimated effect of each factor associated with IFI by using a random effect model. Results : Eight studies were included in the systematic review and five studies were eligible for the meta-analysis. Rates of IFI range from 8-33% in lung transplant recipients. Independent risk factors for invasive aspergillosis (IA) in lung transplantation include previous fungal colonization (OR 2.44; 95% CI 0.08-0.47), cytomegalovirus infection (OR 1.96; 95% CI 1.08-3.56) and single lung transplantation (OR 1.77; 95% CI 1.08-2.91). Pre-emptive antifungal therapy (OR 0.20; 95% CI 0.09-0.48) is a protective factor for IA in lung transplant (OR 0.2; 95% CI 0.08-0.47). Conclusion : Cytomegalovirus infection, previous fungal colonization and single lung transplantation independently increase the risk of IA in lung transplant recipients. Pre-emptive antifungal therapy is a protective factor for IA in the lung transplant population.