Abstract
Background: Aspergillus infections limit survival in lung transplant recipients. This single center retrospective cohort describes our experience with multiple regimens that were used to prevent colonization with Aspergillus spp. after lung transplantation: no antifungal therapy (none), oral voriconazole (voriconazole), and inhaled liposomal amphotericin B (amphotericin).
Methods: Fungal cultures from bronchoalveolar lavages and bronchial washings for a predefined surveillance period following transplantation were assessed for all recipients who received a lung allograft between March 26, 2003 through December 16, 2013 (n = 108). Patients who were colonized prior to transplantation or had multiple treatment strategies before first colonization were excluded. Ninety-one patients were analyzed in groups determined by their initial prophylactic regimen. The event-free survival from colonization up to 730 days after transplant was calculated by the Kaplan-Meier product limit estimator, and survival curves were compared using the log-rank test.
Results: There were no differences in time to colonization with Aspergillus spp. in lung transplant recipients among the groups in the post-transplant period. The point estimate for the hazard ratio (HR) for colonization in the post-transplant period was lower with voriconazole when compared to either amphotericin (HR = 0.71, p = 0.58) or none (HR = 0.37, p = 0.14).
Conclusion: Voriconazole showed a trend towards superiority in preventing colonization with Aspergillus spp.in lung transplant recipients. Due to a limitation in sample size and bias by indication, a dedicated randomized controlled trial is needed to determine the optimal prophylactic regimen in this patient group
