Preemptive treatment with voriconazole in lung transplant recipients. Issue 4 (25th March 2013)

• Record Type: Journal Article
• Authors: Neoh, C.F.; Snell, G.I.; Levvey, B.; Kotsimbos, T.; Morrissey, C.O.; Slavin, M.A.; Stewart, K.; Kong, D.C.M.
• Is Part Of: Transplant infectious disease. Volume 15:Issue 4(2013)
• Page Start: 344
• Page End: 353
• Publication Date: 2013-03-25
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12071
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" xml:lang="en" id="tid12071-abs-0001"> <title>Abstract</title> <sec id="tid12071-sec-0001" sec-type="section"> <title>Background</title> <p>Invasive fungal infection (IFI) is associated with high mortality in lung transplant (LTx) recipients. Data for voriconazole use in preemptive treatment remain scant.</p> </sec> <sec id="tid12071-sec-0002" sec-type="section"> <title>Method</title> <p>A single‐center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post‐LTx colonization.</p> </sec> <sec id="tid12071-sec-0003" sec-type="section"> <title>Results</title> <p>We reviewed 62 adult LTx patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. <italic>Aspergillus fumigatus</italic> (75.8%) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LTx patient (1.6%) had IFI, 47 (75.8%) cleared their colonizing isolate, 3 (4.8%) had persistent colonization, 7 (11.3%) had recurrent colonization, 1 (1.6%) had new colonization, 2 (3.2%) had aspergilloma, and 1 (1.6%) was clinically unstable with no culture results. Sixteen (25.8%) had died by 12 months. Ten (16.1%) had likely drug‐related hepatotoxicity. LTx patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent <italic>Aspergillus</italic> colonization at 6 months (<italic>P</italic> = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12‐month mortality (<italic>P</italic> = 0.007).</p> </sec> <sec id="tid12071-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Voriconazole preemptive treatment resulted in low incidence of IFI and IFI‐related mortality.</p> </sec> </abstract>