Is universal antifungal prophylaxis mandatory in adults after lung transplantation? A review and meta‐analysis of observational studies

Pilarczyk, Kevin; Haake, Nils; Heckmann, Jens; Carstens, Henning; Haneya, Assad; Cremer, Jochen; Jakob, Heinz; Pizanis, Nikolaus; Kamler, Markus

doi:10.1111/ctr.12854

Cited by 36 publications

(26 citation statements)

References 45 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: Current Data On Prevention Strategiesmentioning

confidence: 78%

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: Current Data On Prevention Strategiesmentioning

confidence: 78%

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Bitterman

Marinelli

Husain

2021

JoF

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“…As a consequence, prophylaxis strategies for reducing fungal infection are heterogeneous among lung transplantation centers. A systematic review and meta-analysis, collecting seven studies (mostly retrospective and monocentric) published in 2016, concluded that universal fungal prophylaxis compared with no or targeted prophylaxis reduces the incidence of invasive fungal infection in lung transplant patients (15).…”

Section: Ssi and Antibacterial Prophylaxismentioning

confidence: 99%

Infections after lung transplantation

Nosotti¹,

Tarsia

Morlacchi

2018

J. Thorac. Dis.

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The good clinical result of lung transplantation is constantly undermined by the high incidence of infection, which negatively impacts on function and survival. Moreover, infections may also have immunological interactions that play a role in the acute rejection and in the development of chronic lung allograft dysfunction. There is a temporal sequence in the types of infection that affects lung allograft: in the first postoperative month bacteria are the most frequent cause of infection; following this phase, cytomegalovirus and Pneumocystis carinii are common. Fungal infections are particularly feared due to their association with bronchial complication and high mortality. Scrupulous postoperative surveillance is mandatory for the successful management of lung transplantation patients with respect to early detection and treatment of infections. This paper is aimed to address clinicians in the management of the major infectious complications that affect the lung transplant population.

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“…Adding GM to PCR does not increase the diagnostic sensitivity in these culture‐negative aspergillosis cases, but may increase the clinician's confidence in the diagnosis. We emphasize that these NNTs are rough estimates based on very small numbers of patients and should be regarded as preliminary; nonetheless, these are reasonable numbers given the fact that post‐transplant antifungal prophylaxis, assumed to reduce the risk for IA, was routinely employed at our center.…”

Section: Discussionmentioning

confidence: 99%

Routine comprehensive Aspergillus screening of bronchoalveolar lavage samples in lung transplant recipients

Unterman

Izhakian

Geffen

et al. 2020

Clinical Transplantation

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Background Invasive aspergillosis is a significant cause of morbidity and mortality in lung transplant recipients (LTRs). Early diagnosis may improve outcome, yet is challenging. We assessed the diagnostic yield of a routine, comprehensive, prospectively employed Aspergillus screening strategy in LTRs. Methods During a 6‐month period, all bronchoalveolar lavage (BAL) samples (including post‐transplant surveillance) obtained from LTRs at our center were routinely tested for Aspergillus PCR, galactomannan (GM), and fungal culture. Invasive aspergillosis (IA) was defined using EORTC/MSG and ISHLT criteria for proven and probable aspergillosis. Results Ninety‐five consecutive BAL samples were tested. PCR, GM, and fungal culture were positive in 28.4%, 30.6%, and 7.4%, respectively. Five cases of IA (two proven, three probable) were identified. Fungal culture failed to detect 40% of IA cases, which were detected by a positive PCR and/or GM. However, the majority of positive PCR samples represented colonization (59.3%). Sensitivity of PCR, GM, and culture for IA was 80%, 60%, and 60%, respectively, and specificity was 74%, 71%, and 96%. Conclusions In LTRs, a routine prospectively employed screening strategy in which all BAL samples were screened for Aspergillus PCR and GM, detected aspergillosis cases that were otherwise missed by a false‐negative fungal culture, but resulted in more cases of colonization being detected. Clinical judgment is thus warranted to avoid unnecessary treatment of colonization.

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Is universal antifungal prophylaxis mandatory in adults after lung transplantation? A review and meta‐analysis of observational studies

Cited by 36 publications

References 45 publications

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant

Infections after lung transplantation

Routine comprehensive Aspergillus screening of bronchoalveolar lavage samples in lung transplant recipients

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