title: Is universal antifungal prophylaxis mandatory in adults after lung transplantation? A review and meta-analysis of observational studies.
abstract: Lung transplant (LTX) recipients are at high risk of invasive Aspergillus infections (IAI). However, no randomized-controlled trials (RCT) or international guidelines on antifungal prophylaxis (AFP) in the LTX population exist.
  
  
  
  A meta-analysis was performed to determine whether AFP reduces the rate of IAI after LTX. A total of six eligible observational studies (five with no prophylaxis, one with targeted prophylaxis, three studies including heart/lung transplantation) with a total of 748 patients were included.
  
  
  
  The pooled odds ratio (OR) for IAI (62 IFI in the intervention arm and 82 in the control group) was 0.234 (95% confidence interval [CI] 0.097-0.564, P=0.001, z=-3.237). Pooled studies were characterized by substantial heterogeneity (I2=66.64%); number needed to treat was 6.8. A subgroup analyses with exclusion of heart transplant recipients also showed a statistically significant reduction in IAI with AFP (OR 0.183, 95% CI 0.0449-0.744, P=0.018).
  
  
  
  This study suggests that universal antifungal prophylaxes reduces incidence of IAI after LTX. However, included studies are limited by small sample size, single-center structure without randomization, mixed population (including heart/heart-lung transplant), and heterogeneity due to variations in immunosuppression, type, and duration of AFP. Therefore, there is a clear need for an adequately powered RCT.
authors.affiliation: Department of Intensive Care Medicine, imland Klinik Rendsburg, Rendsburg, Germany.|Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.affiliation: Department of Intensive Care Medicine, imland Klinik Rendsburg, Rendsburg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Haake
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heckmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Carstens
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Kiel, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Pizanis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016041:Heart-Lung Transplantation; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation; D064887:Observational Studies as Topic; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011292:Premedication; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Candida infection; antifungal prophylaxis; aspergillosis; invasive fungal infection; lung transplantation