Nebulized amphotericin B prophylaxis for Aspergillus infection in lung transplantation: study of risk factors

Monforte, Vı́ctor; Román, Antonio; Gavaldá, Joan; Bravo, Carles; Tenorio, Luis Enrique David; Ferrer, Adelaida; Maestre, José; Morell, Ferrán

doi:10.1016/s1053-2498(01)00364-3

Cited by 123 publications

(123 citation statements)

References 31 publications

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“…The IA rate of 1.5% in our study with voriconazole prophylaxis appears to at least be comparable to other universal antifungal prophylactic strategies reported in literature (6,(29)(30)(31)(32). However, it is to be noted that patients in the voriconazole group of our study were biased towards a higher risk of developing IA.…”

Section: Discussionsupporting

confidence: 80%

Voriconazole Prophylaxis in Lung Transplant Recipients

Husain

Paterson

Studer

et al. 2006

American Journal of Transplantation

201

164

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Lung transplant recipients have one of the highest rates of invasive aspergillosis (IA) in solid organ transplantation. We used a single center, nonrandomized, retrospective, sequential study design to evaluate fungal infection rates in lung transplant recipients who were managed with either universal prophylaxis with voriconazole (n = 65) or targeted prophylaxis (n = 30) with itraconazole ± inhaled amphotericin in patients at high risk (pre-or posttransplant Aspergillus colonization [except Aspergillus niger]). The rate of IA at 1 year was better in lung transplant recipients receiving voriconazole prophylaxis as compared to the cohort managed with targeted prophylaxis (1.5% vs. 23%; p = 0.001). Twenty-nine percent of cases in the targeted prophylaxis group were in patients colonized with A. niger who did not receive itraconazole. A threefold or higher increase in liver enzymes was noted in 37-60% of patients receiving voriconazole prophylaxis as compared to 15-41% of patients in the targeted prophylaxis cohort. Fourteen percent in the voriconazole group as compared to 8% in the targeted prophylaxis group had to discontinue antifungal medications due to side effects. Voriconazole prophylaxis can be used in preventing IA in lung transplant recipients. Regular monitoring of liver enzymes and serum concentrations of calcineurin inhibitors are required to avoid hepatotoxicity and nephrotoxicity.

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Section: Discussionsupporting

confidence: 80%

Voriconazole Prophylaxis in Lung Transplant Recipients

Husain

Paterson

Studer

et al. 2006

American Journal of Transplantation

201

164

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“…Other treatment alternatives which have been successfully used include combinations of intravenous amphotericin B and itraconazole (340), aersolized amphotericin B and oral itraconazole (333), and amphotericin B alone (25). Sequential liposomal amphotericin (1.5 to 3.5 mg/kg/day, to a mean total dose of 3.1 g) and then itraconazole (400 mg/day) have been successfully used with at least four patients (203). A single patient who was intolerant of amphotericin B, liposomal amphotericin, and itraconazole and who was successfully treated with terbinafine (250 mg every 12 h by mouth for 3 months) has been described (111).…”

Section: Vol 18 2005 Aspergillus Infections In Transplant Recipientmentioning

confidence: 99%

AspergillusInfections in Transplant Recipients

2005

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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

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“…Invasive Aspergillosen der Anastomosenregion zwischen Trachea und Transplantat sind eine bekannte Komplikation nach Lungen- und Herz-Lungen-Transplantationen [215]. Aspergillus spp.…”

Section: Luftunclassified

Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten

Koch-Institut¹

2010

Bundesgesundheitsbl.

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Nebulized amphotericin B prophylaxis for Aspergillus infection in lung transplantation: study of risk factors

Cited by 123 publications

References 31 publications

Voriconazole Prophylaxis in Lung Transplant Recipients

Voriconazole Prophylaxis in Lung Transplant Recipients

AspergillusInfections in Transplant Recipients

Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten

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