title: Is universal antifungal prophylaxis mandatory in lung transplant patients?
abstract: OBJECTIVE
  Lung transplantation remains the main therapy for patients with end-stage lung disease, yet survival remains limited by infection and chronic rejection. Invasive fungal infection, especially invasive aspergillosis, continues to cause a high rate of mortality after lung transplantation, and there is evidence that fungal colonization in itself may have a negative impact as well. This article reviews clinical trials in primary antifungal prophylaxis to determine whether antifungal prophylaxis after lung transplantation is indicated.
  
  
  RESULTS
  A variety of antifungal regimens have been tested after lung transplantation including itraconazole or voriconazole monotherapy, inhaled amphotericin B products, and combination therapy. Studies using a historical cohort that has not received antifungal prophylaxis show a decrease in the incidence of invasive fungal disease and/or invasive aspergillosis with antifungal prophylaxis, with relatively few safety concerns. Both systemic azoles and inhaled amphotericin B products appear to provide benefit.
  
  
  CONCLUSIONS
  Despite multiple reports of antifungal prophylaxis efficacy, a randomized, controlled, multicenter trial has yet to be performed. The optimal agent or agents for prophylaxis and length of therapy posttransplantation remain unknown. However, sufficient evidence exists for the utility of some type of antifungal prophylaxis posttransplantation for the majority of lung transplant recipients.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. jschaenman@mednet.ucla.edu
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Schaenman
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000517:prevention & control; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D009181:Mycoses / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000935:Antifungal Agents