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Early report on tuberculosis and fungal infections in lung transplant recipients from an African Centre
Background: Lung transplantation (LT) is an established therapy for patients with end-stage lung disease. However, infections remain a leading cause of morbidity and mortality post- transplant. This is the first report of LT related infections from an African setting, where the burden of pathogens s...
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| Language: | English English |
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Department of Medicine
2026
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| Summary: | Background: Lung transplantation (LT) is an established therapy for patients with end-stage lung disease. However, infections remain a leading cause of morbidity and mortality post- transplant. This is the first report of LT related infections from an African setting, where the burden of pathogens such as tuberculosis (TB) and endemic fungi may differ from global trends and thus pose a unique challenge to successful transplantation. Objectives: To describe the incidence, timing, and microbiology of endemic infections such as TB and fungi in lung transplant recipients (LTRs) at Groote Schuur Hospital (GSH), Cape Town, South Africa. Methods: We conducted a retrospective cohort study of all LTRs from 2018 to 2024. Microbiological data from blood and bronchoalveolar lavage (BAL) samples were reviewed. Organisms were categorized by donor or recipient status, site, and time from transplantation. All LT recipients received isoniazid (INH) preventive therapy (IPT) to prevent TB. Results: Among 44 patients (median age 48 years, 46.7% male), one-year survival was 65.8%. Despite high regional TB incidence, no cases of post-transplant TB were detected. Donor-derived TB occurred in 1 case, 1 case of TB was diagnosed on histology of explant lungs, and 4 patients developed transient nucleic acid amplification test positivity in the absence of clinical disease. Fungal infections occurred in 11% of patients, with non-albicans Candida identified in 2 out of 3 cases of candidaemia. Non-fumigatus Aspergillus species were not uncommon and accounted for ~1/3 of cases. CMV pneumonitis occurred in 1 patient (2.3%). Conclusions: This is the first early report of post-LT endemic infections from South Africa. Although we anticipated a significant burden of TB, IPT and intensive surveillance appears to mitigate the risk of immunosuppression. A wide variety of fungal pathogens were identified which raises further questions regarding the diversity of fungi and antifungal prophylaxis in this region. |
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