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Carbapenem-Resistant Klebsiella Pneumoniae in Lung Transplantation Recipients
S306
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
in both EVLP systems at 1 hr (106.8 ± 4.1 vs. 100.7 ± 8.3 ng/ml, p < 0.54 in Swedish; 108.7 ± 1.9 vs. 75.6 ± 8.7 ng/ml, p < 0.03 in Toronto). CD81 was also higher in long cold ischemic time group (less than 8 hr) than in short cold ischemic time group (more than 8 hr) in both systems at 1 hr (105.9 ± 6.1 vs. 93.1 ± 11.3 ng/ml, p < 0.50 in Swedish; 93.2 ± 9.8 vs. 73.3 ± 18.5 ng/ml, p < 0.51 in Toronto). RT-PCR analysis demonstrated that lung specific mRNAs (SFTPA, SFTPB, and SFTPC) were detected in perfusates. The level of SFTPA was 9059 ± 3116 copy/mL at 2 hr in Swedish and 5833 ± 2461 copy/mL at 4 hr in Toronto. Beta-actin level was 18604 ± 3799 copy/mL at 2 hr in Swedish and 23857 ± 5407 copy/mL at 4 hr in Toronto. Conclusion: Lung-specific exosomes containing mRNA of surfactant were detected in perfusates of EVLP. CD81 at 1 hr may be a biomarker of lung injury in EVLP.
CONV groups, respectively (log rank, p= 0.37). Lung function test showed a mean FEV1% of 76% and 79% at 1 year in the EVLP and CONV groups, respectively (p= ns). Lung function continued to show no difference between groups at 2 years of follow-up. Conclusion: At our two centres, time in ICU (and other clinical parameters not shown in abstract) was not different between groups. In addition, shortterm survival up towards 2 years as well as pulmonary function in patients transplanted with lungs evaluated with EVLP seem non-inferior to patients transplanted with conventional donor lungs.
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8( 45)
Lung Transplantation after Ex-Vivo Lung Perfusion in Two Scandinavian Centres T. Nilsson ,1 M. Zemtsovski,2 A. Wallinder,3 I. Henriksson,2 S. Ricksten,1 H. Møller-Sørensen,2 G.C. Riise,4 M. Perch,5 M. Iversen,5 G. Dellgren.6 1Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska Univ Hospital, Goteborg, Sweden; 2Cardiothoracic Anesthesia, Rigshospitalet, Copenhagen, Denmark; 3Cardiothoracic Surgery, Sahlgrenska Univ Hospital, Goteborg, Sweden; 4Transplant Institute, Sahlgrenska Univ Hospital, Goteborg, Sweden; 5Lung Transplant Unit, Rigshospitalet, Copenhagen, Denmark; 6Sahlgrenska Univ Hospital, Goteborg, Sweden.
Carbapenem-Resistant Klebsiella Pneumoniae in Lung Transplantation Recipients L. Morlacchi ,1 V. Rossetti,1 P. Tarsia,1 C. Travierso,1 L. Rosso,2 M. Nosotti,2 F. Blasi.1 1Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano; Università degli Studi di Milano, Milano, Italy; 2U.O. Chirurgia Toracica e dei Trapianti di Polmone, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano; Università degli Studi di Milano, Milano, Italy.
Purpose: Ex vivo lung perfusion (EVLP) is adopted by an increasing number of centres as a means of increasing the numbers of organs available for lung transplantation (LTx). We reviewed our combined clinical long-term outcome in patients transplanted with EVLP lungs and compared it to contemporary controls. Methods: Marginal lungs not fulfilling standard criteria for donation, but with potential for improvement, underwent EVLP between 2011 and 2015, and were transplanted if predefined criteria were met in both centres. We have identical acceptance criteria for EVLP, identical protocol, and similar EVLP device in both centres. Clinical outcome was assessed and compared to a control group of all contemporary patients transplanted with conventional donor lungs (CONV). Results: Fifty-one recipients from the regular waiting list underwent either bilateral lobar (n= 1), single (n= 6) or double (n= 44) LTx with EVLP lungs. Data was compared to a control group of (n= 258) consecutive recipients transplanted with conventional donor lungs during the same time period. Preoperative diagnoses were similar between EVLP and CONV groups. Mean ICU length of stay was 9.3 days (range, 1-65) in the EVLP group and 8.3 days (range, 1-156) (p= ns) in the CONV group. The one-year survival rate was 89.5% (CI 76.5-95.5%) and 83.7% (CI 78.3-87.9%) in the EVLP and
Purpose: The acquisition of Klebsiella pneumoniae carbapemenase producing (KPC) strains has been associated with reduced survival among lung transplant (LuTx) recipients (Raviv Y, Clin Transpl 2012). This case series present the clinical characteristics of KPC infection in LuTx patients at our institution. Methods: This study was a retrospective case-series of lung transplantation recipients who were infected with KPC strains. Data regarding transplant, clinical presentation, treatment and outcome were collected and analyzed. Diagnosis of KCP was based on specific microbiological cultures. Results: KCP infection was diagnosed in 6 patients out of 47 that underwent lung transplant from January 2014 to September 2015. Their histories are depicted in tables 1 and 2. The majority of patients acquired KPC in the post-operative period; each patient had a prolonged (> 30 days) in-hospital stay after the surgery due to difficult respiratory weaning. Conclusion: KPC acquisition is certainly a great concern among lung transplant recipients; however our data showed that mortality related to KPC colonization was relatively low. As previously reported, prolonged hospitalization, particularly ICU-stay, seems to be a very important risk factor for such an infection, as well as malnourishment. Finally, these cases may be useful to draw the physician’s attention to early and quick diagnosis in order to enable immediate isolation of infected persons to prevent further spread.
Abstracts S307 8( 46) Clinical characteristics of patients
Sex, Age LuTx type, Patient at LuTx Indication 1
2
3
4
5
6
Length of ICU stay after LuTx (days); discharge after LuTx (Post Operative Day - POD) Complications
At present
Female, Bilateral, 37 Systemic yrs sclerosis
46; never Failed weaning; Dead at 5 discharged at digestive tract mths home (firstly dysfunction due from LuTx 10 days in to underlying because of rehabilitation disease, resulting MOF due to clinic, then in malnourishment; KPC septic re-hospitalised anxiety and shock again till depression death) Female, Bilateral, Cystic 8; POD 38 Sternal dehiscence Alive at 18 26 Fibrosis (surgically repaired mths from yrs at 6 mths after LuTx; FEV1 LuTx) 91% of best Male, Single left, 22; POD 53 Left vocal cord Alive at 17 65 yrs Idiopathic paralysis and mths from Pulmonary dysphagia from LuTx; FEV1 Fibrosis endotracheal 98% of intubation; stenosis best of the left main bronchus, managed with bronchoscopic balloon dilation Male, Single left, 36; POD 72 Squamous cell Alive at 16 58 yrs Idiopathic carcinoma in mths from Pulmonary the right native LuTx; FEV1 Fibrosis lung, diagnosed 100% of at 12 mths follow best up; cisplatin/ gemcitabine chemotherapy ongoing Female, Bilateral, 7; POD 44 (+ Malnourishment. Dead at 7 47 Wegener's 40 days in Progressive mths from yrs granulomatosis rehabilitation multifocal LuTx due to and clinic) leukoencephalopathy progressive bronchiectasis (PML) due to JCV, PML diagnosed at 5 mths after LuTx. Male, Bilateral, Cystic 27; POD 48 Malnourishment. Alive at 8 17 yrs Fibrosis Diffuse large mths from B-cell lymphoma, LuTx; FEV1 diagnosed at 2 mths 100% of after LuTx; R- CHOP best chemotherapy ongoing
KPC infection; first detection and management Time from LuTx (Post Operative Day -POD) Antibiotic treatment
Patient
Site of detection
1
Bronchoaspirate; POD 50 bronchoalveolar lavage Bronchoaspirate POD 12
2
3
Endobronchial POD 4 swab; pleural effusion; surgical wound swab; bronchoalveolar lavage
4
Bronchoaspirate; urine
POD 29
5
Sputum
POD 116
6
Bronchoalveolar POD 6 lavage; nasal swab; rectal swab
Eradication
Ertapenem + Meropenem No; death due to + Colistin (several KPC septic shock courses) Ertapenem + Meropenem Yes; at 12 mths + Gentamicin+ follow up: Colistin; then BAL and rectal discontinuation swab were both because of negative colonization Ertapenem + Meropenem Yes; at 12 mths + Tigecyclin follow up: + Tobramycin; BAL and rectal Gentamycin; then swab were both discontinuation negative because of colonization At first: Ertapenem No; KPC still present + Meropenem + on urine and Ciprofloxacin + rectal swab at 14 Colistin; Gentamicin; months follow up then discontinuation after LuTx because of colonization None (colonization) No; KPC still present on sputum at 6 mths from LuTx At first: Ertapenem + Not yet Meropenem + Colistin; then discontinuation because of colonization
Donor Derived Disease Transmission Events in Thoracic Organ Transplantation: Data Reviewed by the OPTN Ad Hoc Disease Transmission Advisory Committee J.M. Schaenman ,1 A. Wilk,2 S. Tlusty,2 M.A. Nalesnik,3 M.G. Michaels,4 C. Wolfe,5 D. Kaul.6 1UCLA School of Medicine, Los Angeles, CA; 2United Network for Organ Sharing, Richmond, VA; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4University of Pittsburgh School of Medicine, Pittsburgh, PA; 5Duke University School of Medicine, Durham, NC; 6University of Michigan Medical School of Medicine, Ann Arbor, MI. Purpose: Donor-derived disease transmission can cause significant morbidity and death after organ transplantation. This report represents the largest review of potential donor derived transmission events that include either heart or lung transplant recipients, generated from a review of reports submitted to the OPTN and reviewed by the OPTN DTAC. Methods: Cases of proven or probable disease transmission from 2008-2014 in which thoracic organs were involved were extracted as of August 1, 2015. Individual organ attribution of disease transmission became available after 2012. Results: Probable or proven donor-derived disease was found in 46 lung and 23 heart transplant recipients. For lung transplant recipients, bacterial infections included Mycobacterium tuberculosis, Staphylococcus aureus, and Pseudomonas; Aspergillus was the most common fungal infection reported (see Table). Viral infections were primarily community acquired respiratory viruses. ‘Other’ types of disease were primarily transmission of peanut allergy. For heart transplant recipients, bacterial infections included Acinetobacter, Klebsiella, and Pseudomonas, and fungal infections included Coccidioides and Cryptococcus. Parasitic infections were relatively more common after heart transplantation, and were primarily Toxoplasma and Trypanosoma cruzi. Conclusion: Comparatively, disease in lung transplant recipients reported greater numbers of malignancy, M. tuberculosis, and fungal infection, and diseases were more likely to be reported by the recipient center. Heart transplant recipients reported relatively more parasitic infections. By better understanding the unique challenges seen after thoracic organ transplantation, we can better prevent and mitigate effects of transmission of disease.
Cases of Proven or Probable Donor-Derived Disease Transmission
Lung (n= 46)
Heart (n= 23)
Malignancy Infection Bacterial Viral Fungal Parasitic Other Recipient reported Median time to report (days)
5 (10.9%) 37 (80.4%) 15 (32.6%) 7 (15.2%) 12 (26.1%) 3 (6.5%) 4 (3.8%) 30 (65.2%) 7.5
1 (4.3%) 22 (95.7%) 6 (26.1%) 3 (13.0%) 4 (17.4%) 9 (39.1%) 0 (0%) 9 (39.1%) 43
8( 47) Trichosporon Infection in Lung Transplant Patients: An Emerging Fungal Infection? S.V. Campos ,1 J.N. Almeida Jr,2 M.N. Samano,3 R.M. Carraro,1 A.N. Costa,1 R.O. Teixeira,1 J. Afonso-Jr,1 P.L. Camargo,1 L. Abdalla,3 L.M. Fernandes,3 P.M. Pêgo-Fernandes.3 1Pneumology, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil; 2Central Laboratory Division, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil; 3Thoracic Surgery, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil. Purpose: Invasive fungal infections occurring in solid organ transplant (SOT) patients are associated with significant morbidity and mortality. Possibly because of the increasing exposure to antifungal drugs, more diverse pathogens are now being isolated from these patients. Trichosporon species are ubiquitous basidiomycetes that can colonize the gastrointestinal tract, the respiratory airways, and the skin. Trichosporon is a well-known pathogen in patients with hematologic malignancies, but has rarely been reported in SOT patients.
The Journal of Heart and Lung Transplantation, Vol 35, No 4S, April 2016
in both EVLP systems at 1 hr (106.8 ± 4.1 vs. 100.7 ± 8.3 ng/ml, p < 0.54 in Swedish; 108.7 ± 1.9 vs. 75.6 ± 8.7 ng/ml, p < 0.03 in Toronto). CD81 was also higher in long cold ischemic time group (less than 8 hr) than in short cold ischemic time group (more than 8 hr) in both systems at 1 hr (105.9 ± 6.1 vs. 93.1 ± 11.3 ng/ml, p < 0.50 in Swedish; 93.2 ± 9.8 vs. 73.3 ± 18.5 ng/ml, p < 0.51 in Toronto). RT-PCR analysis demonstrated that lung specific mRNAs (SFTPA, SFTPB, and SFTPC) were detected in perfusates. The level of SFTPA was 9059 ± 3116 copy/mL at 2 hr in Swedish and 5833 ± 2461 copy/mL at 4 hr in Toronto. Beta-actin level was 18604 ± 3799 copy/mL at 2 hr in Swedish and 23857 ± 5407 copy/mL at 4 hr in Toronto. Conclusion: Lung-specific exosomes containing mRNA of surfactant were detected in perfusates of EVLP. CD81 at 1 hr may be a biomarker of lung injury in EVLP.
CONV groups, respectively (log rank, p= 0.37). Lung function test showed a mean FEV1% of 76% and 79% at 1 year in the EVLP and CONV groups, respectively (p= ns). Lung function continued to show no difference between groups at 2 years of follow-up. Conclusion: At our two centres, time in ICU (and other clinical parameters not shown in abstract) was not different between groups. In addition, shortterm survival up towards 2 years as well as pulmonary function in patients transplanted with lungs evaluated with EVLP seem non-inferior to patients transplanted with conventional donor lungs.
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Lung Transplantation after Ex-Vivo Lung Perfusion in Two Scandinavian Centres T. Nilsson ,1 M. Zemtsovski,2 A. Wallinder,3 I. Henriksson,2 S. Ricksten,1 H. Møller-Sørensen,2 G.C. Riise,4 M. Perch,5 M. Iversen,5 G. Dellgren.6 1Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska Univ Hospital, Goteborg, Sweden; 2Cardiothoracic Anesthesia, Rigshospitalet, Copenhagen, Denmark; 3Cardiothoracic Surgery, Sahlgrenska Univ Hospital, Goteborg, Sweden; 4Transplant Institute, Sahlgrenska Univ Hospital, Goteborg, Sweden; 5Lung Transplant Unit, Rigshospitalet, Copenhagen, Denmark; 6Sahlgrenska Univ Hospital, Goteborg, Sweden.
Carbapenem-Resistant Klebsiella Pneumoniae in Lung Transplantation Recipients L. Morlacchi ,1 V. Rossetti,1 P. Tarsia,1 C. Travierso,1 L. Rosso,2 M. Nosotti,2 F. Blasi.1 1Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano; Università degli Studi di Milano, Milano, Italy; 2U.O. Chirurgia Toracica e dei Trapianti di Polmone, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano; Università degli Studi di Milano, Milano, Italy.
Purpose: Ex vivo lung perfusion (EVLP) is adopted by an increasing number of centres as a means of increasing the numbers of organs available for lung transplantation (LTx). We reviewed our combined clinical long-term outcome in patients transplanted with EVLP lungs and compared it to contemporary controls. Methods: Marginal lungs not fulfilling standard criteria for donation, but with potential for improvement, underwent EVLP between 2011 and 2015, and were transplanted if predefined criteria were met in both centres. We have identical acceptance criteria for EVLP, identical protocol, and similar EVLP device in both centres. Clinical outcome was assessed and compared to a control group of all contemporary patients transplanted with conventional donor lungs (CONV). Results: Fifty-one recipients from the regular waiting list underwent either bilateral lobar (n= 1), single (n= 6) or double (n= 44) LTx with EVLP lungs. Data was compared to a control group of (n= 258) consecutive recipients transplanted with conventional donor lungs during the same time period. Preoperative diagnoses were similar between EVLP and CONV groups. Mean ICU length of stay was 9.3 days (range, 1-65) in the EVLP group and 8.3 days (range, 1-156) (p= ns) in the CONV group. The one-year survival rate was 89.5% (CI 76.5-95.5%) and 83.7% (CI 78.3-87.9%) in the EVLP and
Purpose: The acquisition of Klebsiella pneumoniae carbapemenase producing (KPC) strains has been associated with reduced survival among lung transplant (LuTx) recipients (Raviv Y, Clin Transpl 2012). This case series present the clinical characteristics of KPC infection in LuTx patients at our institution. Methods: This study was a retrospective case-series of lung transplantation recipients who were infected with KPC strains. Data regarding transplant, clinical presentation, treatment and outcome were collected and analyzed. Diagnosis of KCP was based on specific microbiological cultures. Results: KCP infection was diagnosed in 6 patients out of 47 that underwent lung transplant from January 2014 to September 2015. Their histories are depicted in tables 1 and 2. The majority of patients acquired KPC in the post-operative period; each patient had a prolonged (> 30 days) in-hospital stay after the surgery due to difficult respiratory weaning. Conclusion: KPC acquisition is certainly a great concern among lung transplant recipients; however our data showed that mortality related to KPC colonization was relatively low. As previously reported, prolonged hospitalization, particularly ICU-stay, seems to be a very important risk factor for such an infection, as well as malnourishment. Finally, these cases may be useful to draw the physician’s attention to early and quick diagnosis in order to enable immediate isolation of infected persons to prevent further spread.
Abstracts S307 8( 46) Clinical characteristics of patients
Sex, Age LuTx type, Patient at LuTx Indication 1
2
3
4
5
6
Length of ICU stay after LuTx (days); discharge after LuTx (Post Operative Day - POD) Complications
At present
Female, Bilateral, 37 Systemic yrs sclerosis
46; never Failed weaning; Dead at 5 discharged at digestive tract mths home (firstly dysfunction due from LuTx 10 days in to underlying because of rehabilitation disease, resulting MOF due to clinic, then in malnourishment; KPC septic re-hospitalised anxiety and shock again till depression death) Female, Bilateral, Cystic 8; POD 38 Sternal dehiscence Alive at 18 26 Fibrosis (surgically repaired mths from yrs at 6 mths after LuTx; FEV1 LuTx) 91% of best Male, Single left, 22; POD 53 Left vocal cord Alive at 17 65 yrs Idiopathic paralysis and mths from Pulmonary dysphagia from LuTx; FEV1 Fibrosis endotracheal 98% of intubation; stenosis best of the left main bronchus, managed with bronchoscopic balloon dilation Male, Single left, 36; POD 72 Squamous cell Alive at 16 58 yrs Idiopathic carcinoma in mths from Pulmonary the right native LuTx; FEV1 Fibrosis lung, diagnosed 100% of at 12 mths follow best up; cisplatin/ gemcitabine chemotherapy ongoing Female, Bilateral, 7; POD 44 (+ Malnourishment. Dead at 7 47 Wegener's 40 days in Progressive mths from yrs granulomatosis rehabilitation multifocal LuTx due to and clinic) leukoencephalopathy progressive bronchiectasis (PML) due to JCV, PML diagnosed at 5 mths after LuTx. Male, Bilateral, Cystic 27; POD 48 Malnourishment. Alive at 8 17 yrs Fibrosis Diffuse large mths from B-cell lymphoma, LuTx; FEV1 diagnosed at 2 mths 100% of after LuTx; R- CHOP best chemotherapy ongoing
KPC infection; first detection and management Time from LuTx (Post Operative Day -POD) Antibiotic treatment
Patient
Site of detection
1
Bronchoaspirate; POD 50 bronchoalveolar lavage Bronchoaspirate POD 12
2
3
Endobronchial POD 4 swab; pleural effusion; surgical wound swab; bronchoalveolar lavage
4
Bronchoaspirate; urine
POD 29
5
Sputum
POD 116
6
Bronchoalveolar POD 6 lavage; nasal swab; rectal swab
Eradication
Ertapenem + Meropenem No; death due to + Colistin (several KPC septic shock courses) Ertapenem + Meropenem Yes; at 12 mths + Gentamicin+ follow up: Colistin; then BAL and rectal discontinuation swab were both because of negative colonization Ertapenem + Meropenem Yes; at 12 mths + Tigecyclin follow up: + Tobramycin; BAL and rectal Gentamycin; then swab were both discontinuation negative because of colonization At first: Ertapenem No; KPC still present + Meropenem + on urine and Ciprofloxacin + rectal swab at 14 Colistin; Gentamicin; months follow up then discontinuation after LuTx because of colonization None (colonization) No; KPC still present on sputum at 6 mths from LuTx At first: Ertapenem + Not yet Meropenem + Colistin; then discontinuation because of colonization
Donor Derived Disease Transmission Events in Thoracic Organ Transplantation: Data Reviewed by the OPTN Ad Hoc Disease Transmission Advisory Committee J.M. Schaenman ,1 A. Wilk,2 S. Tlusty,2 M.A. Nalesnik,3 M.G. Michaels,4 C. Wolfe,5 D. Kaul.6 1UCLA School of Medicine, Los Angeles, CA; 2United Network for Organ Sharing, Richmond, VA; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4University of Pittsburgh School of Medicine, Pittsburgh, PA; 5Duke University School of Medicine, Durham, NC; 6University of Michigan Medical School of Medicine, Ann Arbor, MI. Purpose: Donor-derived disease transmission can cause significant morbidity and death after organ transplantation. This report represents the largest review of potential donor derived transmission events that include either heart or lung transplant recipients, generated from a review of reports submitted to the OPTN and reviewed by the OPTN DTAC. Methods: Cases of proven or probable disease transmission from 2008-2014 in which thoracic organs were involved were extracted as of August 1, 2015. Individual organ attribution of disease transmission became available after 2012. Results: Probable or proven donor-derived disease was found in 46 lung and 23 heart transplant recipients. For lung transplant recipients, bacterial infections included Mycobacterium tuberculosis, Staphylococcus aureus, and Pseudomonas; Aspergillus was the most common fungal infection reported (see Table). Viral infections were primarily community acquired respiratory viruses. ‘Other’ types of disease were primarily transmission of peanut allergy. For heart transplant recipients, bacterial infections included Acinetobacter, Klebsiella, and Pseudomonas, and fungal infections included Coccidioides and Cryptococcus. Parasitic infections were relatively more common after heart transplantation, and were primarily Toxoplasma and Trypanosoma cruzi. Conclusion: Comparatively, disease in lung transplant recipients reported greater numbers of malignancy, M. tuberculosis, and fungal infection, and diseases were more likely to be reported by the recipient center. Heart transplant recipients reported relatively more parasitic infections. By better understanding the unique challenges seen after thoracic organ transplantation, we can better prevent and mitigate effects of transmission of disease.
Cases of Proven or Probable Donor-Derived Disease Transmission
Lung (n= 46)
Heart (n= 23)
Malignancy Infection Bacterial Viral Fungal Parasitic Other Recipient reported Median time to report (days)
5 (10.9%) 37 (80.4%) 15 (32.6%) 7 (15.2%) 12 (26.1%) 3 (6.5%) 4 (3.8%) 30 (65.2%) 7.5
1 (4.3%) 22 (95.7%) 6 (26.1%) 3 (13.0%) 4 (17.4%) 9 (39.1%) 0 (0%) 9 (39.1%) 43
8( 47) Trichosporon Infection in Lung Transplant Patients: An Emerging Fungal Infection? S.V. Campos ,1 J.N. Almeida Jr,2 M.N. Samano,3 R.M. Carraro,1 A.N. Costa,1 R.O. Teixeira,1 J. Afonso-Jr,1 P.L. Camargo,1 L. Abdalla,3 L.M. Fernandes,3 P.M. Pêgo-Fernandes.3 1Pneumology, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil; 2Central Laboratory Division, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil; 3Thoracic Surgery, Heart Institute of Sao Paulo Medical School, Sao Paulo, Brazil. Purpose: Invasive fungal infections occurring in solid organ transplant (SOT) patients are associated with significant morbidity and mortality. Possibly because of the increasing exposure to antifungal drugs, more diverse pathogens are now being isolated from these patients. Trichosporon species are ubiquitous basidiomycetes that can colonize the gastrointestinal tract, the respiratory airways, and the skin. Trichosporon is a well-known pathogen in patients with hematologic malignancies, but has rarely been reported in SOT patients.