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Antifungal prophylaxis in lung transplant: A survey of United States' transplant centers
Author(s) -
Pennington Kelly M.,
Yost Kathleen J.,
Escalante Patricio,
Razonable Raymund R.,
Kennedy Cassie C.
Publication year - 2019
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13630
Subject(s) - medicine , transplantation , intensive care medicine , amphotericin b , lung transplantation , amphotericin b deoxycholate , antifungal , surgery , dermatology , caspofungin
Background Antifungal prophylaxis strategies for lung transplant recipients vary without consensus or standard of care. Our current study aims to identify antifungal prophylaxis practices in the United States. Methods From November 29, 2018, to February 15, 2019, we emailed surveys to medical directors of adult lung transplant centers. An alternate physician representative was approached if continued non‐response after three survey attempts. Descriptive statistics were used to report findings. Results Forty‐four of 62 (71.0%) eligible centers responded. All Organ Procurement and Transplantation Networks were represented. Only four (9.1%) centers used pre‐transplant prophylaxis for prevention of tracheobronchitis (3 of 4) and invasive fungal disease (4 of 4). Thirty‐nine of forty (97.5%) centers used post‐transplant prophylaxis: 36 (90.0%) universal and 3 (7.5%) pre‐emptive/selective prophylaxis. Most centers used nebulized amphotericin with a systemic agent (26 of 36, 72.2%). Thirty‐two of thirty‐six (88.9%) centers continued universal prophylaxis beyond the hospital setting. Duration of prophylaxis ranged from the post‐transplant hospitalization to lifelong with most centers (25 of 36, 69.4%) discontinuing prophylaxis 6 months or less post‐transplant. Conclusion Most United States' lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for 6 months or less post‐transplant. Very few centers use pre‐transplant antifungal prophylaxis.