Aspergillus and other fungal infections are common causes of morbidity and mortality in lung transplant recipients. Most patients receive prophylaxis against fungal infections, but the optimal regimen has not been defined. The purpose of this study was to assess the efficacy of voriconazole as fungal prophylaxis.
We retrospectively reviewed data from 56 lung transplant recipients. Group A (n = 23) consisted of patients who underwent transplantation after the introduction of voriconazole prophylaxis. Group B (n=23) consisted of patients transplanted immediately prior to the introduction of voriconazole, in whom itraconazole was used as prophylaxis. Both groups received inhaled amphotericin B during their initial hospitalization adn continued oral antifungal prophylaxis until one year post-transplantation. The primary endpoint was positive BAL fungal cultures during the first year. We also assessed clnical events related to aspergillus and overall mortality.
The incidence of patients with positive bronchial cultures for aspergillus at 1 year was 5/28 (18%) in the group A and 10/28 (36%) in group B (p = 0.134, ns). At the time of recovery of aspergillus, 4/5 (80%) patients in group A were actually receiving voriconazole, versus 90% (9/10) in group B receiving itraconazole. The incidence of patients with positive bronchial cultures for candida was 0 in group A versus 50% (14/28) in group B (p = < 0.0001). At one year, there was one clinical aspergillus event in each group, non-fatal in group A and fatal in group B. There was an additional fatal aspergillus event in group B at month 25, as well as an episode of scedosporium sepsis at month 13.
In our lung transplant population, the use of voriconazole results in decreased airway colonization with aspergillus and candida.
These findings suggest that voriconazole is effective antifungal prophylaxis for lung transplant recipients. The overall low rate of clinically significant fungal events do not allow any further conclusions to be drawn.
John Sherner, None.