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Preemptive treatment with voriconazole in lung transplant recipients
Author(s) -
Neoh C.F.,
Snell G.I.,
Levvey B.,
Kotsimbos T.,
Morrissey C.O.,
Slavin M.A.,
Stewart K.,
Kong D.C.M.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12071
Subject(s) - voriconazole , medicine , incidence (geometry) , colonization , retrospective cohort study , surgery , antifungal , microbiology and biotechnology , physics , dermatology , optics , biology
Background Invasive fungal infection ( IFI ) is associated with high mortality in lung transplant ( LT x) recipients. Data for voriconazole use in preemptive treatment remain scant. Method A single‐center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post‐ LT x colonization. Results We reviewed 62 adult LT x 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. Aspergillus fumigatus (75.8%) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LT x 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. LT x patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months ( P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12‐month mortality ( P = 0.007). Conclusions Voriconazole preemptive treatment resulted in low incidence of IFI and IFI ‐related mortality.