The Effectiveness of Culture-Directed Preemptive Anti-Aspergillus Treatment in Lung Transplant Recipients at One Year After Transplant
Bibliographic record
Abstract
BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a significant complication after lung transplantation. However, the risk factors for IPA in patients colonized with Aspergillus species, and the effectiveness of culture-directed preemptive treatment, are not well known. METHODS: We studied 328 lung transplant recipients, from January 2006 to July 2009, with 1-year follow-up. Risk factors and effectiveness of culture-directed preemptive treatment were evaluated via a Cox-proportional hazard model. RESULTS: Seventy-one recipients (21.6%) developed invasive fungal infections, including 29 patients (8.8%) with IPA. Only 48.3% (14/29) of patients with IPA had pretransplantation or posttransplantation airway colonization with Aspergillus spp. In the Cox-proportional hazard model, treatment with rabbit antithymocyte globulin was significantly associated with posttransplant IPA in patients with Aspergillus colonization (hazards ratio, 4.25; 95% confidence interval, 1.09-16.6). Preemptive antifungal treatment for 3 months was significantly associated with a lower rate of IPA (0% [0/36] vs 18% [14/77]; P = 0.003, odds ratio, 0.8; 95% confidence interval, 0.7-0.9) but did not impact mortality. CONCLUSIONS: Our data suggest that almost half the cases of IPA occurred in patients without pretransplantation or posttransplantation airway colonization with Aspergillus spp. Among patients with Aspergillus colonization, use of rabbit antithymocyte globulin was associated with 4-fold risk of subsequent development of IPA. Invasive pulmonary aspergillosis was an independent risk factor for 1-year mortality. Use of preemptive antifungal treatment for 3 months may be associated with significant reduction of IPA without influencing mortality.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".