Routine comprehensive Aspergillus screening of bronchoalveolar lavage samples in lung transplant recipients

Avraham Unterman, Shimon Izhakian, Yuval Geffen, Dror Rosengarten, Osnat Shtraichman, Barak Pertzov, Baruch Vainshelboim, Hagar Alon, Yael Raviv, Mordechai R. Kramer

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Background: Invasive aspergillosis is a significant cause of morbidity and mortality in lung transplant recipients (LTRs). Early diagnosis may improve outcome, yet is challenging. We assessed the diagnostic yield of a routine, comprehensive, prospectively employed Aspergillus screening strategy in LTRs. Methods: During a 6-month period, all bronchoalveolar lavage (BAL) samples (including post-transplant surveillance) obtained from LTRs at our center were routinely tested for Aspergillus PCR, galactomannan (GM), and fungal culture. Invasive aspergillosis (IA) was defined using EORTC/MSG and ISHLT criteria for proven and probable aspergillosis. Results: Ninety-five consecutive BAL samples were tested. PCR, GM, and fungal culture were positive in 28.4%, 30.6%, and 7.4%, respectively. Five cases of IA (two proven, three probable) were identified. Fungal culture failed to detect 40% of IA cases, which were detected by a positive PCR and/or GM. However, the majority of positive PCR samples represented colonization (59.3%). Sensitivity of PCR, GM, and culture for IA was 80%, 60%, and 60%, respectively, and specificity was 74%, 71%, and 96%. Conclusions: In LTRs, a routine prospectively employed screening strategy in which all BAL samples were screened for Aspergillus PCR and GM, detected aspergillosis cases that were otherwise missed by a false-negative fungal culture, but resulted in more cases of colonization being detected. Clinical judgment is thus warranted to avoid unnecessary treatment of colonization.

Original languageEnglish
Article numbere13811
JournalClinical Transplantation
Issue number3
StatePublished - 1 Mar 2020
Externally publishedYes


  • Aspergillus
  • aspergillosis
  • galactomannan
  • lung transplant
  • polymerase chain reaction
  • testing


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