Antifungal Prophylaxis During the Early Postoperative Period of Lung Transplantation

Calvo, Vı́ctor; Borro, J.M.; Morales, P.; Morcillo, Alfonso; Vicente, R.; Tarrazona, Vicente; París, F.

doi:10.1378/chest.115.5.1301

Cited by 112 publications

(82 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Small case series and reports have documented the efficacy of itraconazole as antifungal prophylaxis in colonized patients (42,110). However, rigorous clinical trials showing its efficacy in lung transplant recipients are lacking.…”

Section: Organ Transplant Recipientsmentioning

confidence: 99%

AspergillusInfections in Transplant Recipients

2005

View full text Add to dashboard Cite

Aspergillus infections are occurring with an increasing frequency in transplant recipients. Notable changes in the epidemiologic characteristics of this infection have occurred; these include a change in risk factors and later onset of infection. Management of invasive aspergillosis continues to be challenging, and the mortality rate, despite the use of newer antifungal agents, remains unacceptably high. Performing molecular studies to discern new targets for antifungal activity, identifying signaling pathways that may be amenable to immunologic interventions, assessing combination regimens of antifungal agents or combining antifungal agents with modulation of the host defense mechanisms, and devising diagnostic assays that can rapidly and reliably diagnose infections represent areas for future investigations that may lead to further improvement in outcomes

show abstract

Section: Organ Transplant Recipientsmentioning

confidence: 99%

AspergillusInfections in Transplant Recipients

2005

View full text Add to dashboard Cite

show abstract

“…However, there is no uniform approach to the prevention of these fungal infections (8)(9)(10). (11)(12)(13)(14)(15) Figure 1).…”

Section: Lung Transplantation Is a Complex Procedures Indicated In Patmentioning

confidence: 99%

Antifungal Prophylaxis with Voriconazole or Itraconazole in Lung Transplant Recipients: Hepatotoxicity and Effectiveness

Cadena

Levine

Angel

et al. 2009

American Journal of Transplantation

104

View full text Add to dashboard Cite

Invasive fungal infections (IFI) are common after lung transplantation and there are limited data for the use of antifungal prophylaxis in these patients. Our aim was to compare the safety and describe the effectiveness of universal prophylaxis with two azole regimens in lung transplant recipients. This is a retrospective study in lung transplant recipients from July 2003 to July 2006 who received antifungal prophylaxis with itraconazole or voriconazole plus inhaled amphotericin B to compare the incidence of hepatotoxicity. Secondary outcomes include describing the incidence of IFI, clinical outcomes after IFI and mortality.Sixty-seven consecutive lung transplants received antifungal prophylaxis, 32 itraconazole and 35 voriconazole and inhaled amphotericin B. There were no significant differences between groups in the acute physiology and chronic health evaluation (APACHE) score at the time of transplantation, demographic characteristics, comorbidities and concomitant use of hepatotoxic medications. Hepatotoxicity occurred in 12 patients receiving voriconazole and inhaled amphotericin B and in no patients receiving itraconazole (p < 0.001). There was no significant difference between groups with regard to the percentage of transplants with IFI, but one case of zygomycosis occurred in a transplant treated with voriconazole. Voriconazole prophylaxis after lung transplantation was associated with a higher incidence of hepatotoxicity and similar clinical effectiveness when compared to itraconazole.

show abstract

“…It is important that potential transplantation candidates are screened for pre-existing fungal infections. Patients with positive cultures for Aspergillus and clinical or radiological signs suggesting an infection are usually given a therapy such as¯uconazole for Candida or itraconazole and aerosolized amphotericin B for Aspergillus until signs of infection disappear [57].…”

Section: Prophylaxis Of Fungal Infectionsmentioning

confidence: 99%

“…day -1 ) divided into three doses and oral¯uconazole (400 mg . day -1 ) during the postoperative period prevented the early occurrence of any fungal infection in 52 lung transplant recipients [57]. Some groups have started using 15 mg amphotericin B twice daily for 2±3 months, as prophylaxis, with excellent preliminary results and little or no toxicity.…”

Section: Prophylaxis Of Fungal Infectionsmentioning

confidence: 99%

Fungal infections in transplant recipients

Nicod

Howarth

2001

Eur Respir J

View full text Add to dashboard Cite

Fungi are ubiquitous and the respiratory tract is exposed to aerosolized spores of both fungi that are “pathogenic” even in the normal host, such asCryptococus neoformans, and those that are “opportunistic”, such asCandidaandAspergillusspecies, among others. Although these latter species may occasionally form fungal balls or induce allergic phenomena in the normal host, they produce more invasive diseases in immunosuppressed patients. Among these diseases, pseudomembranous aspergillosis has recently been described.The diagnostic approach to these entities, and, in particular, the thin dividing line between colonization and infection are addressed, along with the diagnostic value of the various procedures.New prophylactic regimens are reviewed such as the possibility of using amphotericin aerosols in combination with systemic azole administration.The authors would emphasize the importance of restoring lung defences by not only decreasing immunosuppressive regimens but also considering the use of newly available recombinant cytokines such as growth factors, to reduce neutropenia, for instance, in addition to antifungal drugs when infection is diagnosed. However, immunomodulation procedures are far from being well established.

show abstract

Antifungal Prophylaxis During the Early Postoperative Period of Lung Transplantation

Cited by 112 publications

References 12 publications

AspergillusInfections in Transplant Recipients

AspergillusInfections in Transplant Recipients

Antifungal Prophylaxis with Voriconazole or Itraconazole in Lung Transplant Recipients: Hepatotoxicity and Effectiveness

Fungal infections in transplant recipients

Contact Info

Product

Resources

About