Diagnostic value of Galactomannan in Tracheobronchial Aspirate for Aspergillus infection in lung transplant recipients (the GALACTBAS study)

Background: Lung transplant recipients (LTR) are highly susceptible to Aspergillus infection (AI), but diagnosis may be limited by the invasiveness of bronchoalveolar lavage fluid (BALF) collection. Proximal airway samples may provide a less invasive alternative. Methods: We conducted a retrospectiv...

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Detalles Bibliográficos
Autores: Monforte-Pallarés, Arnau|||0000-0002-5468-3885, Martin-Gomez, M. Teresa|||0000-0001-8119-8749, Berastegui García, Cristina|||0000-0001-9774-9349, Marquez-Algaba, Ester|||0000-0002-9824-0138, Sacanell, Judith, Rosado Rodríguez, Joel|||0000-0001-9308-7827, Falcó Roget, Anna, Escudero, Gonzalo, Casanovas, Jose, Kirkegaard, Cristina|||0000-0001-9035-1450, Sáez-Giménez, Berta|||0000-0002-9307-728X, Monforte, Víctor|||0000-0002-2918-7679, Gavaldà, Joan|||0000-0002-9829-3141, Len, Oscar|||0000-0002-1819-3141, Los-Arcos, Ibai|||0000-0001-8835-2702
Tipo de recurso: artículo
Fecha de publicación:2026
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::5ec0f8bc6662fba231b31144705a3f83
Acceso en línea:https://ddd.uab.cat/record/327398
Access Level:acceso embargado
Palabra clave:Fungal infection
Lung transplantation
32 invasive aspergillosis
Pulmonary
Descripción
Sumario:Background: Lung transplant recipients (LTR) are highly susceptible to Aspergillus infection (AI), but diagnosis may be limited by the invasiveness of bronchoalveolar lavage fluid (BALF) collection. Proximal airway samples may provide a less invasive alternative. Methods: We conducted a retrospective single-center study including all adult LTR (March 2018 - March 2022) who underwent bronchoscopy with tracheobronchial aspirate (TBA) and BALF galactomannan (GM) testing in the same procedure. They were processed for mycological culture and EIA-based GM (Bio-Rad) after cysteine homogenization. AI was defined according to ISHLT consensus. A ROC curve for TBA GM and its diagnostic performance were assessed. Results: A total of 545 paired TBA-BALF samples from 282 LTR were analyzed. Proven or probable AI was diagnosed in 22 samples (4%). The optimal TBA GM cut-off was ≥0.54 optical density index (ODI), yielding 95.2% sensitivity, 92% specificity, and an AUC of 0.97 (95% CI, 0.95-0.99). In comparison, BALF GM at ≥1.0 ODI showed 33.3% sensitivity and 99.6% specificity (AUC 0.88, 95% CI, 0.80-0.95), although BALF GM values were significantly higher in invasive infections compared with non-invasive infections (1.49 vs. 0.14; p-value = 0.007). TBA cultures were more frequently positive than BALF (24% vs 9.9%). Finally, TBA and BALF GM values demonstrated moderate correlation (r = 0.54), and combined testing with concordant results improved accuracy to 99.6%.

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