A 2-year Review of the Diagnostic Performance of Serum and Bronchoalveolar Lavage Galactomannan Testing in Lung Transplant Recipients in a National Heart and Lung Transplant Centre.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-11-11 DOI:10.1111/tid.14404

Clare O'Donnell, Breda Lynch, Louise O'Sullivan, Assumpta Killarney, Michelle Murray, Peter Riddell, Margaret M Hannan

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引用次数: 0

Abstract

Background: The 2015 International Society for Heart and Lung Transplant (ISHLT) fungal guidelines recommend the use of bronchoalveolar lavage (BAL) galactomannan over serum galactomannan for the diagnosis of invasive aspergillosis (IA) in lung transplant (LTx) recipients, based on limited evidence. Galactomannan testing is costly.

Methods: A single-center, retrospective cohort study reviewing all 814 serum and BAL galactomannan samples received from 184 LTx recipients in our center between 2021 and 2022 and assessing their diagnostic performance in the diagnosis of IA.

Results: Over the study period, 394 serum galactomannan samples were received from 144 patients and 420 BAL galactomannan samples from 143 patients. Using a cut-off of ≥ 1.0 for BAL galactomannan, the sensitivity and specificity were 65.9% and 98.4%, respectively. In total, 30 patients had positive BAL galactomannan. Antifungal therapy was commenced or continued in 29 of these patients either as targeted or pre-emptive treatment. Using a cut-off of ≥ 0.5 for serum galactomannan, the sensitivity and specificity were 9.7% and 99.7%, respectively. In total, four patients had a positive serum galactomannan. All four patients were either already on antifungal treatment for IA or were started before the serum galactomannan result was available, supported by laboratory, clinical, and radiological findings. A positive serum galactomannan was used to monitor treatment response in one patient.

Conclusion: Serum galactomannan is not a valuable test in the diagnosis of IA in our LTx recipients, is costly, and does not remove the need for bronchoscopy and BAL galactomannan. This supports the ISHLT recommendation.

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国家心肺移植中心对肺移植受者进行血清和支气管肺泡灌洗液半乳甘露聚糖检测的两年诊断效果回顾。

背景：基于有限的证据，2015年国际心肺移植学会（ISHLT）真菌指南建议使用支气管肺泡灌洗液（BAL）半乳甘露聚糖而非血清半乳甘露聚糖诊断肺移植（LTx）受者的侵袭性曲霉菌病（IA）。半乳甘露聚糖检测费用昂贵：一项单中心回顾性队列研究回顾了本中心在2021年至2022年期间从184名肺移植受者处获得的所有814份血清和BAL半乳甘露聚糖样本，并评估了它们在诊断IA中的诊断性能：在研究期间，共收到144名患者的394份血清半乳甘露聚糖样本和143名患者的420份BAL半乳甘露聚糖样本。以 BAL 半乳甘露聚糖≥1.0 为临界值，灵敏度和特异度分别为 65.9% 和 98.4%。共有 30 名患者的 BAL 半乳糖甘露聚糖呈阳性。其中 29 名患者开始或继续接受抗真菌治疗，无论是作为靶向治疗还是先期治疗。以血清半乳甘露聚糖≥ 0.5 为临界值，灵敏度和特异度分别为 9.7% 和 99.7%。共有四名患者的血清半乳甘露聚糖呈阳性。根据实验室、临床和放射学检查结果，这四名患者要么已经在接受抗真菌治疗，要么在获得血清半乳甘露聚糖结果之前就已经开始接受治疗。一名患者的血清半乳甘露聚糖呈阳性，可用于监测治疗反应：结论：血清半乳甘露聚糖并非诊断LTx受试者IA的重要检测指标，其成本较高，且无法消除支气管镜检查和BAL半乳甘露聚糖检查的必要性。这支持 ISHLT 的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.