Antifungal prophylaxis in lung transplant recipients: A systematic review and meta‐analysis

Pennington, Kelly; Baqir, Misbah; Erwin, Patricia J.; Razonable, Raymund R.; Murad, Mohammad Hassan; Kennedy, Cassie C.

doi:10.1111/tid.13333

Cited by 18 publications

(15 citation statements)

References 43 publications

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“…Three systematic reviews and meta-analyses have been published to date on this subject [ 64 , 65 , 66 ]. Two of the systematic reviews reached a similar conclusion.…”

Section: Prevention Strategiesmentioning

confidence: 99%

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Bitterman

Marinelli

Husain

2021

JoF

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Long-term survival after lung transplantation is lower than that associated with other transplanted organs. Infectious complications, most importantly invasive fungal infections, have detrimental effects and are a major cause of morbidity and mortality in this population. Candida infections predominate in the early post-transplant period, whereas invasive mold infections, usually those related to Aspergillus, are most common later on. This review summarizes the epidemiology and risk factors for invasive fungal diseases in lung transplant recipients, as well as the current evidence on preventive measures. These measures include universal prophylaxis, targeted prophylaxis, and preemptive treatment. Although there is consensus that a preventive strategy should be implemented, current data show no superiority of one preventive measure over another. Data are also lacking regarding the optimal antifungal regimen and the duration of treatment. As all current recommendations are based on observational, single-center, single-arm studies, it is necessary that this longstanding debate is settled with a multicenter randomized controlled trial.

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“…Three systematic reviews and meta-analyses have been published to date on this subject [ 64 , 65 , 66 ]. Two of the systematic reviews reached a similar conclusion.…”

Section: Prevention Strategiesmentioning

confidence: 99%

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Bitterman

Marinelli

Husain

2021

JoF

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“…Second, surveys merely describe individual center's practice preferences, which may not represent evidence-based approaches. Indeed, several systematic reviews and meta-analyses of antifungal prophylaxis in LT published between 2001 and 2019 failed to offer any insight into the best approach to preventing IFI due to heterogeneity of published studies/trials, high risk of bias and lack of precision (63). The lack of standardized post-LT care poses particular challenges.…”

Section: Prevention Of Ifismentioning

confidence: 99%

Fungal infections in lung transplantation

Samanta¹,

Clancy²,

Nguyen³

2021

J Thorac Dis

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Lung transplant is a potential life-saving procedure for chronic lung diseases. Lung transplant recipients (LTRs) are at the greatest risk for invasive fungal infections (IFIs) among solid organ transplant (SOT) recipients because the allograft is directly exposed to fungi in the environment, airway and lung host defenses are impaired, and immunosuppressive regimens are particularly intense. IFIs occur within a year of transplant in 3-19% of LTRs, and they are associated with high mortality, prolonged hospital stays, and excess healthcare costs. The most common causes of post-LT IFIs are Aspergillus and Candida spp.; less common pathogens are Mucorales, other non-Aspergillus moulds, Cryptococcus neoformans, Pneumocystis jirovecii, and endemic mycoses. The majority of IFIs occur in the first year following transplant, although later onset is observed with prolonged antifungal prophylaxis. The most common manifestations of invasive mould infections (IMIs) include tracheobronchial (particularly at anastomotic sites), pulmonary and disseminated infections. The mortality rate of tracheobronchitis is typically low, but local complications such as bronchomalacia, stenosis and dehiscence may occur. Mortality rates associated with lung and disseminated infections can exceed 40% and 80%, respectively. IMI risk factors include mould colonization, single lung transplant and augmented immunosuppression. Candidiasis is less common than mould infections, and manifests as bloodstream or other non-pulmonary invasive candidiasis; tracheobronchial infections are encountered uncommonly. Risk factors for and outcomes of candidiasis are similar to those of non lung transplant recipients. There is evidence that IFIs and fungal colonization are risk factors for allograft failure due to chronic rejection. Mould-active azoles are frontline agents for treatment of IMIs, with local debridement as needed for tracheobronchial disease. Echinocandins and azoles are treatments for invasive candidiasis, in keeping with guidelines in other patient populations. Antifungal prophylaxis is commonly administered, but benefits and optimal regimens are not defined. Universal mould-active azole prophylaxis is used most often. Other approaches include targeted prophylaxis of high-risk LTRs or pre-emptive therapy based on culture or galactomannan (GM) (or other biomarker) results. Prophylaxis trials are needed, but difficult to perform due to heterogeneity in local epidemiology of IFIs and standard LT practices. The key to devising rational strategies for preventing IFIs is to understand local epidemiology in context of institutional clinical practices.

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“… 92 Subsequently, two recent meta-analyses reveal no difference in the odds of fungal infection with universal prophylaxis compared to no prophylaxis following LTx. 93 , 94 Long-term exposure to antifungal medication has been reported as the major risk factor in the emergence of multiresistant fungal infections post-LTx 85 and the question remains as to whether universal prophylaxis risks breeding increased resistance to first-line antifungal medication without a mortality benefit.…”

Section: Fungal Infectionsmentioning

confidence: 99%

Management of Multidrug Resistant Infections in Lung Transplant Recipients with Cystic Fibrosis

Vazirani¹,

Crowhurst²,

Morrissey³

et al. 2021

IDR

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Cystic fibrosis (CF) is an inherited multisystem disease characterised by bronchiectasis and chronic respiratory infections which eventually cause end stage lung disease. Lung transplantation (LTx) is a well-established treatment option for patients with CF-associated lung disease, improving survival and quality of life. Navigating recurrent infections in the setting of LTx is often difficult, where immune suppression must be balanced against the constant threat of infection. Sepsis/infections are one of the major contributors to post-LTx mortality and multiresistant organisms (eg, Burkholderia cepacia complex, Mycobacterium abscessus complex, Scedosporium spp. and Lomentospora spp.) pose a significant threat to survival. This review will summarize current and novel therapies to assist with the management of multiresistant bacterial, mycobacterial, viral and fungal infections which threaten the CF LTx cohort.

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Antifungal prophylaxis in lung transplant recipients: A systematic review and meta‐analysis

Cited by 18 publications

References 43 publications

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Fungal infections in lung transplantation

Management of Multidrug Resistant Infections in Lung Transplant Recipients with Cystic Fibrosis

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