Studies of prophylactic itraconazole (ITR) in lung transplant recipients (LTR) are lacking. Our purpose was to evaluate LTR who received ITR prophylaxis and the association between trough concentration (conc.) and identification of fungal pathogens.

We conducted a retrospective study of adult LTR from 2014–2016. We collected data on clinical features, medication, microbiology, and ITR trough conc. Incidence of identified fungal pathogens was compared between 2 groups based upon the recommended target trough conc. for prophylaxis of 0.5 mg/L from the British Society for Medical Mycology.

We identified 229 LTR on 169,000 days of ITR. 540 trough conc. measurements were analyzed. The distribution of initial conc. is shown. We divided patients into 2 groups: all levels ≥0.5, i.e. “target” (n=154 [67%]); at least one level <0.5, i.e. “non-target” (n=75 [33%]). Median duration of ITR between groups was similar: 716 vs. 788 days. The primary outcome was identification of a fungal pathogen in BAL fluid. 43 (28%) in the target group were found to have a fungal pathogen, significantly higher compared to 12 (16%) in the non-target group (p=0.05). Most were Aspergillus species (81 and 67%, respectively). Only 8 patients were colonized pretransplant. Median time to pathogen isolation was shorter in the target group: 124 vs. 329 days. The incidence rate of pathogen identification per 100 patient days was higher in the target group: 0.04 vs. 0.02 (rate ratio=1.8; p=0.06). Fungal pathogen-free survival is illustrated.

Maintaining levels ≥0.5 did not prevent isolation of fungal pathogens and was actually associated with 1.8 times higher incidence rate. The recommended target ITR trough conc. for prophylaxis of 0.5 based on hematology patients may not be applicable. More data in LTR are critically needed given widespread ITR use and high mortality from fungal infection.

CITATION INFORMATION: Hassouna H., Athans V., Brizendine K. Itraconazole Prophylaxis, Trough Concentration, and Identification of Fungal Pathogens in Lung Transplant Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress