Background: Fungal infection is a common complication after lung transplant (LuTx). Our study aims to assess the role of microbiological surveillance for optimizing antifungaltreatment.

Methods: This was a monocentric retrospective study including all adult patients who underwent LuTx between January 2019 and December 2022 and survived at least 90 days.Our routine survellaince consists of bronchoalveolar lavage (BAL) at 3, 6, 12 months after LuTx and then every 12 months. We useuniversal prophylaxis with voriconazole for the first 6 months after LuTx (exceptions are made in case of hepatotoxicity) and then shift to itraconazole if BAL is negative for fungi.

Results: 86 patients were considered. 302 BALs were performed during the period of interest, 29 were positive for fungi, with a total of 35 isolates, as reported in image 1. Based on these findings, 8 patients needed a change in their antifungal therapy, see image 1 for details. Wereport 2 false positives: patients were completely asymptomatic with no radiological sign; therefore, they underwent another CT scan andBAL, both negative.

Conclusion: Our study shows the significance of microbiological surveillance in detecting fungi in patients otherwise asymptomatic and its key role in guiding prompt therapeutic changes. Nevertheless, fungal growth in BAL alone is not sufficient in driving a major therapeutic change and has to be complemented with clinical and radiological findings.