BACKGROUND: Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasive aspergillosis and candidiasis. The antifungal strategy that optimally balances effective reduction of IFD with a minimum of toxicity remains undefined; universal triazole prophylaxis is common at lung transplantation (LT) centers, despite the well-known toxicities and costs of this approach. METHODS: We implemented an antifungal strategy in March 2007 targeted at LT recipients at highest risk for IFD based on our institutional epidemiology. All patients received inhaled amphotericin B during their initial LT hospitalization, bilateral lung transplant recipients received 7 to 10 days of micafungin, and only patients with growth of yeast or mold in their day-of-transplant cultures received further oral antifungal therapy tailored to their fungal isolate. RESULTS: IFD events were assessed in sequential cohorts composed of 82 lung transplant recipients before and 83 patients after the implementation of this targeted antifungal strategy. We observed a sharp decline in IFD; in the second cohort, 87%, 91%, and 96% of patients were free of IFD, invasive candidiasis, and invasive aspergillosis at 1 year. Only 19% of patients in the second cohort received systemic antifungal therapy beyond the initial LT hospitalization, and no patients experienced antifungal drug-related toxicity or IFD-associated mortality. CONCLUSIONS: The targeted antifungal strategy studied seems to be a reasonable approach to reducing post-LT IFD events while limiting treatment-related toxicities and costs.
BACKGROUND: Lung transplant recipients are at high risk of invasive fungal disease (IFD), particularly invasive aspergillosis and candidiasis. The antifungal strategy that optimally balances effective reduction of IFD with a minimum of toxicity remains undefined; universal triazole prophylaxis is common at lung transplantation (LT) centers, despite the well-known toxicities and costs of this approach. METHODS: We implemented an antifungal strategy in March 2007 targeted at LT recipients at highest risk for IFD based on our institutional epidemiology. All patients received inhaled amphotericin B during their initial LT hospitalization, bilateral lung transplant recipients received 7 to 10 days of micafungin, and only patients with growth of yeast or mold in their day-of-transplant cultures received further oral antifungal therapy tailored to their fungal isolate. RESULTS: IFD events were assessed in sequential cohorts composed of 82 lung transplant recipients before and 83 patients after the implementation of this targeted antifungal strategy. We observed a sharp decline in IFD; in the second cohort, 87%, 91%, and 96% of patients were free of IFD, invasive candidiasis, and invasive aspergillosis at 1 year. Only 19% of patients in the second cohort received systemic antifungal therapy beyond the initial LT hospitalization, and no patients experienced antifungal drug-related toxicity or IFD-associated mortality. CONCLUSIONS: The targeted antifungal strategy studied seems to be a reasonable approach to reducing post-LT IFD events while limiting treatment-related toxicities and costs.
Authors: Christopher S Kovacs; Christine E Koval; David van Duin; Amanda Guedes de Morais; Blanca E Gonzalez; Robin K Avery; Steven D Mawhorter; Kyle D Brizendine; Eric D Cober; Cyndee Miranda; Rabin K Shrestha; Lucileia Teixeira; Sherif B Mossad Journal: World J Transplant Date: 2014-06-24
Authors: David S Y Ong; Peter M C Klein Klouwenberg; Cristian Spitoni; Marc J M Bonten; Olaf L Cremer Journal: Crit Care Date: 2013-10-11 Impact factor: 9.097
Authors: Kelly M Pennington; Hayley J Dykhoff; Xiaoxi Yao; Lindsey R Sangaralingham; Nilay D Shah; Steve G Peters; Jason N Barreto; Raymund R Razonable; Cassie C Kennedy Journal: Ann Am Thorac Soc Date: 2021-03
Authors: Serena Dollive; Ying-Yu Chen; Stephanie Grunberg; Kyle Bittinger; Christian Hoffmann; Lee Vandivier; Christopher Cuff; James D Lewis; Gary D Wu; Frederic D Bushman Journal: PLoS One Date: 2013-08-19 Impact factor: 3.240
Authors: T O Hirche; C Knoop; H Hebestreit; D Shimmin; A Solé; J S Elborn; H Ellemunter; P Aurora; M Hogardt; T O F Wagner Journal: Pulm Med Date: 2014-03-30