When Less is More

The proverb ‘out of the frying pan and into the fire’ describes the situation faced by those who undergo lung transplantation. For these people, the life-saving surgery is often a last resort; however, the procedure itself carries many associated risks—some of which are life-threatening.

 

One such risk is contracting a lung infection, such as that caused by the fungus Aspergillus. If Aspergillus spreads from the lungs to other organs, it results in a condition known as invasive aspergillosis, which can lead to brain damage or even death. To prevent this, clinicians often treat all patients with anti-fungal medications, regardless of an individual patient’s risk of infection; however, these medications can have serious side effects, such as kidney damage. 

 

Finding a way to identify lung transplant patients who are at risk of fungal infections would ensure that only those who would benefit from medications are treated. 

 

In a study involving over 500 lung transplant patients, Dr.  Shahid Husain, Affiliate Scientist at the Toronto General Hospital Research Institute and Medical Director of the Transplant Infectious Diseases clinic at UHN's Multi-Organ Transplant Program, tested the effectiveness of an innovative way to identify those at risk. Their approach involved two tests: the first looked for Aspergillus in the lung; and the second looked for galactomannan, a fungal product that serves as a marker of invasive aspergillosis. Based on the results of these tests, only those that tested positive were treated with specific anti-fungal medications. 

 

The team found that this targeted approach accurately identified the patients that needed treatment, and the patients that did not require anti-fungal medications. Overall, it reduced the patients’ exposure to anti-fungal medications by half—while significantly reducing the risk of invasive aspergillosis and without affecting patient survival one year later. 

 

“The results of our study suggest that treating lung transplant patients with anti-fungal medications is not warranted unless there is evidence of infection or invasive aspergillosis,” explains Dr. Husain. “This study forms the basis for more rigorous research into the benefits of this targeted treatment approach for patients and for cost savings to the health care system.”