Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group.
BACKGROUND
Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients.


METHODS
From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period.


RESULTS
The mean (+/- SD) postoperative period duration was 49 +/- 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised.


CONCLUSIONS
In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients.
Calvo
V
V
Hospital Universitario La Fe, Valencia, Spain. vcalvo@separ.es
Borro
J M
JM
Morales
P
P
Morcillo
A
A
Vicente
R
R
Tarrazona
V
V
París
F
F
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D009894:Opportunistic Infections / Q000517:prevention & control*; D011184:Postoperative Period; D015996:Survival Rate
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D000666:Amphotericin B; D015725:Fluconazole