ABSTRACTBackground Aspergillus is the most frequent fungal pathogen after lung transplantation, ranging from asymptomatic colonization to invasive disease. Treatment outcomes of aspergillosis in real-life settings remain insufficiently characterized because of the complexity and heterogeneity of its clinical presentations. Methods We conducted a retrospective study of all adult lung transplant recipients followed at Toulouse University Hospital from 2014 to 2024. Patients were stratified as Aspergillus-free, colonized, or treated for pulmonary aspergillosis (PA). Clinical, radiological, microbiological, functional, and survival outcomes were assessed in PA group. Results Among 174 patients, 46% were Aspergillus-free, 30% colonized, and 24% treated for pulmonary aspergillosis. The overall isolation rate was 54%, predominantly A. fumigatus (60%), with Aspergillus bronchitis as the most frequent form (57%). At diagnosis, 86% of treated patients were symptomatic, mainly with dyspnea (60%) and cough (48%). First-line therapy, most commonly voriconazole or isavuconazole combined with inhaled liposomal amphotericin B, required second-line adjustment in 62% of cases. At 12 months, 60% showed clinical and 67% radiological improvement, with significant gains in FVC and FEV₁ at 6 months (p = 0.0067), maintained at 12 months. Overall survival did not differ significantly between groups (p = 0.33), and five-year survival reached 80%, exceeding historical data. Conclusion In our cohort, patients treated for Aspergillus infection after lung transplantation had survival outcomes comparable to those with colonization or without Aspergillus. Despite heterogeneity in treatment approaches, proactive antifungal therapy was associated with clinical, functional, and radiological improvements, supporting early and individualized treatment strategies.
Lelièvre et al. (2026) studied this question.