Background: Because invasive aspergillosis is a major complication in lung transplant recipients (LT-R), many centers employ voriconazole (VOR) prophylaxis. It is controversial whether there is an associated rise in VOR-resistant mould colonization or true infections (VRM-CI) with Scedosporium apiospermum and prolificans (SA and SP), Fusarium (FUS), or Mucorales (MUC). We aimed to determine if VOR use after LT increases VRM-CI risk.
Methods: We performed a single-center review of LT-R from February 2000 to October 2012. In 2004, the 3-month prophylaxis protocol changed from inhaled amphotericin (iA) only to VOR and iA. We reviewed SA, SP, MUC, and FUS microbiology, and radiology to determine colonization versus true infection. All SP, MUC and only confirmed resistant FUS and SA were considered VRM-CI. Patients who received iA only or VOR ± iA were eligible for analysis.
Results: In 383 LT performed, 356 patients were included in the study: 88 (25%) received iA only, and 268 (75%) received VOR ± iA. Among 35 positive cultures, 54% (15 MUC, 4 SA/SP) were colonizations and 46% (6 MUC, 9 SA/SP, 1 FUS) were true infections. The median time to first positive culture was 369 days (interquartile range 146-930). 35 positive cultures were identified among 30 patients. Among 88 who received iA only, 6.8% (6/88) had VRM-CI compared to 9.0% (24/268) in the VOR ± iA group (p=0.51). 94% (33/35) of cultures were from respiratory specimens. In a multivariate analysis, there was moderate evidence that heart-lung transplants are associated with VRM-CI (OR 10.15, 95% CI 0.96-107.66, p=0.05). There were no significant associations with age, gender, or induction agents.
Conclusions: Compared with inhaled iA only, a VOR based prophylaxis regimen after LT was not associated with increased risk of VRM-CI. Consideration of VRM-CI risk may not be warranted in the decision to administer VOR prophylaxis after surgery.
To cite this abstract in AMA style:Kim J, Cohen S, Allen E, Boettger R, Binstock M, Arron S, Singer J, Hays S, Kukreja J, Chin-Hong P. Post-Transplant Colonization and Infection with Voriconazole-Resistant Mould in Lung Transplant Recipients Receiving Voriconazole Prophylaxis [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/post-transplant-colonization-and-infection-with-voriconazole-resistant-mould-in-lung-transplant-recipients-receiving-voriconazole-prophylaxis/. Accessed December 2, 2023.
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