Purpose: Echinocandins are a class of antifungal drugs that have activity against Aspergillus species. However, the use of echinocandins in LTRs is not well reported. We assessed the indications.

Methods: Analysis on 523 LTRs between January 2010 and December 2014. We assessed antifungal therapy use in LTRs during the first 6 weeks post-transplant.

Results: In our cohort of 523 LTRs, 31.9% (167/ 523) patients received antifungal therapy for following indications, 65% (108/ 167) for targeted anti-fungal prophylaxis, 30 % (51/167) for pre-emptive anti-fungal therapy, and 5% (8/167) for invasive fungal infection therapy. Azoles were used as first line agents in 86 % (143/167 recipients. Caspofungin was used as a first line agent in 7 % (13/167), followed by micafungin 4 %( 7/167 and Amphotericin B used in 2% (4/167). Overall 22% (31/143) were switched from azoles. Of these 42% (13/31) were switched to echinocandins, the indication for changing from azoles to echinocandins was hepatotoxicity 46 % (6/13), followed by acute kidney injury, and undesirable drug interaction 7.6% each. None of the recipients receiving echinocandins developed hepatotoxicity or acute kidney injury during the first 6 weeks of therapy.

Conclusion: Our data suggest that echinocandins are used in one in five LTRs and are the preferred second line agents owing to the adverse effects of azoles.

CITATION INFORMATION: AlJishi Y, Rotstein C, Kumar D, Humar A, Singer L, Keshavjee S, Husain S. Echinocandins in Lung Transplant Recipients (LTRs). Am J Transplant. 2017;17 (suppl 3).

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