AUTHOR=Beeckmans Hanne , Van Roy Elfri , Kaes Janne , Sacreas Annelore , Geudens Vincent , Vermaut Astrid , Willems Lynn , Jin Xin , Bos Saskia , Vanstapel Arno , Van Slambrouck Jan , Orlitova Michaela , Vanaudenaerde Bart , Ceulemans Laurens J. , Van Raemdonck Dirk , Neyrinck Arne P. , Godinas Laurent , Dupont Lieven J. , Verleden Geert M. , Vos Robin 

TITLE=Aspergillus-Specific IgG Antibodies are Associated With Fungal-Related Complications and Chronic Lung Allograft Dysfunction After Lung Transplantation

JOURNAL=Transplant International

VOLUME=36

YEAR=2023

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2023.10768

DOI=10.3389/ti.2023.10768

ISSN=1432-2277

ABSTRACT=<p>Fungal exposure and sensitization negatively affect outcomes in various respiratory diseases, however, the effect of fungal sensitization in lung transplant (LTx) recipients is still unknown. We performed a retrospective cohort study of prospectively collected data on circulating fungal specific IgG/IgE antibodies, and their correlation with fungal isolation, chronic lung allograft dysfunction (CLAD) and overall survival after LTx. 311 patients transplanted between 2014 and 2019 were included. Patients with elevated <italic>Aspergillus fumigatus</italic> or <italic>Aspergillus flavus</italic> IgG (10%) had more mold and <italic>Aspergillus</italic> species isolation (<italic>p</italic> = 0.0068 and <italic>p</italic> = 0.0047). <italic>Aspergillus fumigatus</italic> IgG was specifically associated with <italic>Aspergillus fumigatus</italic> isolation in the previous or consecutive year (AUC 0.60, <italic>p</italic> = 0.004 and AUC 0.63, <italic>p</italic> = 0.022, respectively). Elevated <italic>Aspergillus fumigatus</italic> or <italic>Aspergillus flavus</italic> IgG was associated with CLAD (<italic>p</italic> = 0.0355), but not with death. <italic>Aspergillus fumigatus</italic>, <italic>Aspergillus flavus</italic> or <italic>Aspergillus niger</italic> IgE was elevated in 19.3% of patients, but not associated with fungal isolation, CLAD or death. Mold isolation and <italic>Aspergillus</italic> species isolation from respiratory cultures were associated with CLAD occurrence (<italic>p</italic> = 0.0011 and <italic>p</italic> = 0.0005, respectively), and <italic>Aspergillus</italic> species isolation was also associated with impaired survival (<italic>p</italic> = 0.0424). Fungus-specific IgG could be useful in long-term follow-up post-LTx, as a non-invasive marker for fungal exposure, and thus a diagnostic tool for identifying patients at risk for fungal-related complications and CLAD.</p>