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. 2021 Mar;18(3):468-476.
doi: 10.1513/AnnalsATS.202003-267OC.

The Impact of Antifungal Prophylaxis in Lung Transplant Recipients

Kelly M Pennington  1   2 , Hayley J Dykhoff  2 , Xiaoxi Yao  2   3   4 , Lindsey R Sangaralingham  2   5 , Nilay D Shah  2   3 , Steve G Peters  1   6 , Jason N Barreto  7 , Raymund R Razonable  6   8 , Cassie C Kennedy  1   2   6
Affiliations

The Impact of Antifungal Prophylaxis in Lung Transplant Recipients

Kelly M Pennington et al. Ann Am Thorac Soc. 2021 Mar.

Abstract

Rationale: Many lung transplant centers prescribe antifungal medications after transplantation to prevent invasive fungal infections (IFIs); however, the effectiveness of antifungal prophylaxis at reducing the risk of all-cause mortality or IFI has not been established.Objectives: We aimed to evaluate the effect of antifungal prophylaxis on all-cause mortality and IFI in lung transplant patients.Methods: Using administrative claims data, we identified adult patients who underwent lung transplantation between January 1, 2005, and December 31, 2018. Propensity score analysis using inverse probability treatment-weighting approach was used to balance the differences in baseline characteristics between those receiving antifungal prophylaxis and those not receiving antifungal prophylaxis. Cox proportional hazards regression was used to compare rates of all-cause mortality and IFI in both groups.Results: We identified 662 lung transplant recipients (LTRs) (387 received prophylaxis and 275 did not). All-cause mortality was significantly lower in those receiving antifungal prophylaxis compared with those not receiving antifungal prophylaxis (event rate per 100 person-years, 8.36 vs. 19.49; hazard ratio, 0.43; 95% confidence interval, 0.26-0.71; P = 0.003). Patients receiving antifungal prophylaxis had a lower rate of IFI compared with those not receiving prophylaxis (event rate per 100 person-years, 14.94 vs. 22.37; hazard ratio, 0.68; 95% confidence interval, 0.44-1.05; P = 0.079), but did not reach statistical significance.Conclusions: In this real-world analysis, antifungal prophylaxis in LTRs was associated with reduced all-cause mortality compared with those not receiving antifungal prophylaxis. Rates of IFI were also lower in those receiving prophylaxis, but this was not statistically significant in our primary analysis.

Keywords: Aspergillus; antifungal prophylaxis; fungal infections; lung transplant; triazole.

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Figures

Figure 1.
Figure 1.
Ratio of lung transplant recipients receiving antifungal prophylaxis to those not receiving prophylaxis over time. LTR = lung transplant recipient.
Figure 2.
Figure 2.
Cumulative risk for mortality in lung transplant recipients receiving antifungal prophylaxis compared with those receiving no antifungal prophylaxis. CI = confidence interval.
Figure 3.
Figure 3.
Cumulative risk for mortality in lung transplant recipients receiving antifungal prophylaxis with mold-active triazole compared with those receiving no antifungal prophylaxis. CI = confidence interval.
Figure 4.
Figure 4.
Cumulative risk for fungal infection in lung transplant recipients receiving antifungal prophylaxis compared with those receiving no antifungal prophylaxis. CI = confidence interval.
Figure 5.
Figure 5.
Cumulative risk for fungal infections in lung transplant recipients receiving antifungal prophylaxis with a mold-active triazole agent compared with those receiving no antifungal prophylaxis. CI = confidence interval.
See this image and copyright information in PMC

Comment in

  • Antifungal Prophylaxis.
    Johnson DC, Paez AP. Johnson DC, et al. Ann Am Thorac Soc. 2021 Oct;18(10):1755-1756. doi: 10.1513/AnnalsATS.202103-300LE. Ann Am Thorac Soc. 2021. PMID: 33901407 Free PMC article. No abstract available.
  • Reply: Antifungal Prophylaxis.
    Pennington KM, Razonable RR, Kennedy CC. Pennington KM, et al. Ann Am Thorac Soc. 2021 Oct;18(10):1755-1756. doi: 10.1513/AnnalsATS.202104-445LE. Ann Am Thorac Soc. 2021. PMID: 33901414 Free PMC article. No abstract available.

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