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

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 or IgG (10%) had more mold and species isolation ( = 0.0068 and = 0.0047). IgG was specifically associated with isolation in the previous or consecutive year (AUC 0.60, = 0.004 and AUC 0.63, = 0.022, respectively). Elevated or IgG was associated with CLAD ( = 0.0355), but not with death. , or IgE was elevated in 19.3% of patients, but not associated with fungal isolation, CLAD or death. Mold isolation and species isolation from respiratory cultures were associated with CLAD occurrence ( = 0.0011 and = 0.0005, respectively), and species isolation was also associated with impaired survival ( = 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.