Antifungal Prophylaxis in Lung Transplant: A Survey of United States’ Transplant Centers.
Clin Transplant. 2019 Jun 07;:e13630
Authors: Pennington KM, Yost KJ, Escalante P, Razonable RR, Kennedy CC
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 six months or less post-transplant.
CONCLUSION: Most United States’ lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for six months or less post-transplant. Very few centers use pre-transplant antifungal prophylaxis. This article is protected by copyright. All rights reserved.
PMID: 31173402 [PubMed – as supplied by publisher]