Control of Early Aspergillus Mortality After Lung Transplantation: Outcome and Risk Factors

Eriksson, Mari; Lemström, Karl; Suojaranta-Ylinen, Raili; Martelius, Timi; Harjula, Ari; Sipponen, J; Halme, Maija; Piilonen, Anneli; Salmenkivi, Kaisa; Anttila, Veli-Jukka; Hämmäinen, Pekka

doi:10.1016/j.transproceed.2010.09.116

Cited by 21 publications

(26 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In comparison with other antifungal agents, the echinocandins have fewer significant drug‐drug interactions and dose adjustments were not often required with the use of cyclosporine, which have been previously described. Cyclosporine has been shown to increase caspofungin concentrations; however, the clinical relevance is uncertain …”

Section: Discussionmentioning

confidence: 99%

“…Cyclosporine has been shown to increase caspofungin concentrations 18 ; however, the clinical relevance is uncertain. [19][20][21][22] In contrast, the azoles have a predisposition to produce elevated liver function tests. It has been reported that up to 32.4% of patients discontinued voriconazole prophylaxis owing to liver function test abnormalities.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Echinocandin use in lung transplant recipients

Jishi

Rotstein

Kumar

et al. 2018

Clinical Transplantation

View full text Add to dashboard Cite

Background Invasive fungal infections (IFI) are associated with significant morbidity and mortality in lung transplant recipients (LTRs). However, data outlining use of echinocandins in prophylaxis and therapy of LTRs are limited. Method A single‐center retrospective cohort study on all LTRs from January‐2010 to December‐2016. Participants were screened for antifungal use to assess rate, tolerability, and clinical outcome of echinocandin use in LTRs, during the first 6 weeks of posttransplant. Results A total of 777 lung transplants were reviewed in 763 LTRs. Antifungals were administered to 268 (35%) of LTRs. Reasons included preemptive antifungal therapy (55% [149/268]), targeted antifungal prophylaxis (34% [92/268]), and definitive IFI therapy (10% [27/268]). Azoles were first‐line agents in 80% (215/268) of LTRs, caspofungin in 11% (30/268), micafungin in 6.7% (18/268), amphotericin B in 1.5% (4/268), and anidulafungin in 0.4% (1/268]). LTRs were started on echinocandins due to abnormal liver enzymes in 91% (46/49). Overall, 23% (50/215) of LTR's were switched off azoles. Of these, 54% (27/50) were switched to echinocandins. Switch from azoles to echinocandin was undertaken due to abnormal liver enzymes in 63% (17/27). No patients receiving first‐line echinocandins were switched to other therapies due to adverse events. Conclusions Our data suggest that echinocandins are utilized in approximately 18.3% of lung transplant recipients. They are the preferred second‐line agents due to a lower adverse‐effect profile compared to the azoles.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Echinocandin use in lung transplant recipients

Jishi

Rotstein

Kumar

et al. 2018

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…Most are retrospective 7,20,22,32-45 and noncomparative. 22,33,34,36,38,39,[42][43][44][45][46][47][48] Of comparative trials, 7,20,[31][32][33]35,37,40,41,45,49,50 all used a nonrandomized, sequential design, with the exception of Drew et al 51 Although the majority of studies evaluated inhaled formulations of amphotericin B alone, 7,22,31,35,47,51 in combination with, 20,40,43 or as compared with other antifungals, 22,36,37,40,51 universal or targeted 20,50 prophylaxis with oral administration of fluconazole, 20,36,40,49 itraconazole, 20,33,34,…”

Section: Efficacy Of Antifungal Prophylaxis Regimensmentioning

confidence: 99%

“…Key published studies evaluating the efficacy of antifungal prophylaxis in lung transplant recipients are summarized in Table 2. 7,15,20,22,31,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]51 Although inhaled formulations of amphotericin B remain the most widely studied agent for antifungal prophylaxis, their optimal dosages, formulations, and durations of therapy remain unknown. [52][53][54] In pharmacokinetic studies performed in lung transplant recipients, inhaled deoxycholate amphotericin B achieves high concentrations in the lower airways of transplanted lungs, but concentrations at the bronchial anastomosis and in native lungs (in the case of single-lung transplant) are lower.…”

Section: Efficacy Of Antifungal Prophylaxis Regimensmentioning

confidence: 99%

“…22,31,32,35,37,40,47,49,51 Daily administration for short periods of time (4-14 days) followed by once weekly or every other week administration for 1 to 3 months has also proved successful. 36,43,47,51 The concentrations of inhaled amphotericin B lipid complex (measured in epithelial lining fluid) and inhaled liposomal amphotericin B (in bronchoalveolar lavage aliquots) remain above typical minimum inhibitory concentrations of Aspergillus for at least 7 days, enabling once-weekly administration. 56,57 However, this route of administration does not protect against extrapulmonary infections, in particular, early postoperative pleural space infection due to Candida.…”

Section: Efficacy Of Antifungal Prophylaxis Regimensmentioning

confidence: 99%

See 1 more Smart Citation

Antifungal Prophylaxis in Lung Transplant Recipients

Patel

Eschenauer²,

Stuckey³

et al. 2016

Transplantation

View full text Add to dashboard Cite

Invasive fungal infection remains a serious postoperative complication in lung transplant recipients and is associated with significant morbidity and mortality. Although most lung transplant centers use antifungal prophylaxis, consensus on the strategy, choice of antifungal agent(s), route of administration, and duration of prophylaxis have not been established. This review provides an overview of the epidemiology and risk factors for common fungal infections seen in lung transplant recipients, evaluates the clinical efficacy and toxicity of the various antifungal agents used to prevent infection, and offers recommendations and opportunities for future research. Currently available data evaluating the efficacy of antifungal prophylaxis strategies is limited by a lack of prospective, randomized clinical trial data and variability in patient populations, prophylactic and immunosuppressive strategies, dosing, durations of use of antifungal agents, and definitions of invasive infection. There is controversy regarding significant risk factors for invasive fungal infection, which has limited the development and validation of targeted prophylactic strategies. Inhaled formulations of amphotericin B remain the most widely studied option for universal prophylaxis and have been shown to be effective in reducing the incidence of invasive Aspergillosis as compared with no prophylaxis. Concern over early postoperative extrapulmonary infection may suggest a benefit of initial prophylaxis with a systemic azole. Long-term use of systemic antifungals is not optimal due to emerging evidence of long-term toxicities. Multicenter, randomized trials are needed to ascertain the optimal prophylactic strategy in lung transplant recipients. New agents and delivery mechanisms may offer additional opportunities for comparative research.

show abstract

Anti-Aspergillus Prophylaxis in Lung Transplantation: A Systematic Review and Meta-analysis

Bhaskaran

Mumtaz

Husain

2013

Curr Infect Dis Rep

View full text Add to dashboard Cite

Aspergillus is the most common cause of invasive fungal infection in lung transplant recipients. Most transplant centers employ routine antifungal prophylaxis to prevent the development of invasive aspergillosis (IA). We identified 22 studies from the literature to perform a systematic review and meta-analysis, in order to assess the development of IA and Aspergillus colonization with and without antifungal prophylaxis. Similarly, differences in the toxicities of different formulations of amphotericin-B and azoles were analyzed. Nineteen of 235 (8.1 %) and 28 of 196 (14.3 %) developed IA in the universal prophylaxis and no-prophylaxis arms, respectively (RR: 0.36, CI: 0.05-2.62). We did not find a significant reduction in IA or Aspergillus colonization with universal anti-aspergillus prophylaxis. There was no difference in the adverse events of inhaled amphotericin-B deoxycholate and lipid formulations of inhaled amphotericin-B. However, voriconazole was more hepatotoxic than itraconazole. These results should be interpreted with caution due to heterogeneity of the studies. A multicenter randomized controlled trial is warranted to assess the efficacy of anti-aspergillus prophylaxis in lung transplant recipients.

show abstract

Control of Early Aspergillus Mortality After Lung Transplantation: Outcome and Risk Factors

Cited by 21 publications

References 23 publications

Echinocandin use in lung transplant recipients

Echinocandin use in lung transplant recipients

Antifungal Prophylaxis in Lung Transplant Recipients

Anti-Aspergillus Prophylaxis in Lung Transplantation: A Systematic Review and Meta-analysis

Contact Info

Product

Resources

About