Session Name: Lung: All Topics
Session Date & Time: None. Available on demand.
*Purpose: Fungal infections are responsible for approximately 15-35% of all infections in lung transplant recipients; 80% of which are due to aspergillus or candida. At our institution, voriconazole and inhaled amphotericin B are used for primary fungal prophylaxis post-lung transplantation for a total duration of six months. The objective of this study was to compare the time to first positive fungal culture in patients receiving voriconazole or inhaled amphotericin B.
*Methods: This retrospective, single-center, chart review included adult patients, who received a lung transplant at TUH between January 2012 and June 2019 and continued follow up for at least one-year post-transplantation. The primary endpoint was the time to first positive aspergillus (blood or respiratory) or candida (blood only) culture within six months of lung transplantation. Secondary endpoints included the incidence of positive fungal cultures at one-year and the need for discontinuation of prophylaxis due to adverse events.
*Results: Five hundred sixty-eight patients were screened for eligibility, 439 patients were included in the efficacy analysis and 471 patients were included in the safety analysis. Voriconazole was switched to inhaled amphotericin B in 55.9% of patients receiving it for initial prophylaxis and 19.3% of patients receiving it for chronic prophylaxis due to adverse events. The most common reasons for the switch were altered mental status and elevated liver function tests, respectively.
|Variable||All Patients (n = 439)||Amphotericin (n = 305)||Voriconazole (n = 134)||P Value|
|Age||64.32 ± 8.93||64.74 ± 9.07||63.35 ± 8.54||0.133|
|Male||290 (66.1)||205 (67.2)||85 (63.4)||0.441|
|Double Lung Transplant||163 (37.1)||106 (34.8)||57 (42.5)||0.171|
|Positive Fungal Culture||29 (6.6)||18 (5.9)||11 (8.2)||0.370|
|Positive Aspergillus Respiratory Culture||24 (5.5)||13 (4.3)||11 (8.2)||0.094|
|Positive Candida Blood Culture||5 (1.1)||5 (1.6)||0 (0)||0.329|
*Conclusions: Voriconazole and inhaled amphotericin B are both efficacious for fungal prophylaxis post-lung transplantation. There was no difference in the incidence of positive aspergillus cultures between prophylactic regimens. However, all five cases of candida-positive blood cultures were observed in patients receiving inhaled amphotericin B. The small number of positive cultures limit the ability to draw definitive conclusions. A significant number of patients receiving voriconazole required a change in prophylaxis due to adverse events.
To cite this abstract in AMA style:Shah I, Mohrien K, Rose C, Au J. Evaluation of Fungal Prophylaxis Post-Lung Transplantation [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-fungal-prophylaxis-post-lung-transplantation/. Accessed September 21, 2021.
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