title: Voriconazole prophylaxis in lung transplant recipients.
abstract: Lung transplant recipients have one of the highest rates of invasive aspergillosis (IA) in solid organ transplantation. We used a single center, nonrandomized, retrospective, sequential study design to evaluate fungal infection rates in lung transplant recipients who were managed with either universal prophylaxis with voriconazole (n = 65) or targeted prophylaxis (n = 30) with itraconazole +/- inhaled amphotericin in patients at high risk (pre- or posttransplant Aspergillus colonization [except Aspergillus niger]). The rate of IA at 1 year was better in lung transplant recipients receiving voriconazole prophylaxis as compared to the cohort managed with targeted prophylaxis (1.5% vs. 23%; p = 0.001). Twenty-nine percent of cases in the targeted prophylaxis group were in patients colonized with A. niger who did not receive itraconazole. A three-fold or higher increase in liver enzymes was noted in 37-60% of patients receiving voriconazole prophylaxis as compared to 15-41% of patients in the targeted prophylaxis cohort. Fourteen percent in the voriconazole group as compared to 8% in the targeted prophylaxis group had to discontinue antifungal medications due to side effects. Voriconazole prophylaxis can be used in preventing IA in lung transplant recipients. Regular monitoring of liver enzymes and serum concentrations of calcineurin inhibitors are required to avoid hepatotoxicity and nephrotoxicity.
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh Medical Center, Pennsylvania, USA.
authors.forename: S
authors.initials: S
authors.lastname: Husain
authors.forename: D L
authors.initials: DL
authors.lastname: Paterson
authors.forename: S
authors.initials: S
authors.lastname: Studer
authors.forename: J
authors.initials: J
authors.lastname: Pilewski
authors.forename: M
authors.initials: M
authors.lastname: Crespo
authors.forename: D
authors.initials: D
authors.lastname: Zaldonis
authors.forename: K
authors.initials: K
authors.lastname: Shutt
authors.forename: D L
authors.initials: DL
authors.lastname: Pakstis
authors.forename: A
authors.initials: A
authors.lastname: Zeevi
authors.forename: B
authors.initials: B
authors.lastname: Johnson
authors.forename: E J
authors.initials: EJ
authors.lastname: Kwak
authors.forename: K R
authors.initials: KR
authors.lastname: McCurry
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology; D018890:Chemoprevention; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011336:Probability; D011743:Pyrimidines / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole