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Background: Fungal infections remain one of the major causes of morbidity and mortality after lung transplantation. Inhaled amphotericin B is one of the prophylaxis modalities for fungal infection either alone or in combination with systemic antifungals that is employed by different transplant centers. There is no consensus regarding the dose, duration and frequency of nebulized amphotericin B. Breakthrough fungal infections has been reported mostly with fungi that are known to be resistant to amphotericin B. In this study, we aimed to evaluate safety and efficacy of using aerosolized amphotericin B in preventing fungal infection post lung transplantation.
Materials/methods: This was a retrospective, observational cohort study. We included all 132 lung transplant patients between 2010 and 2017 at King Faisal Specialist Hospital & Research Center (KFSH&RC). Eighty-Four patients received nebulized amphotericin B and met the inclusion criteria. The primary endpoint was occurrence of proven lung fungal infections within the first 12 months post transplantation which was defined as the presence of positive cultures or cytological fungal elements from respiratory specimen. Secondary endpoint was inhaled amphotericin B side effects. Data was collected from patients’ electronic medical records, using REDCap software. Statistical analysis was performed using SPSS software.
Results: All patients received prophylaxis for 3 months after lung transplantation. Breakthrough Aspergillosis infection occurred in 11 patients (13%). After the discontinuation of inhaled amphotericin B, six patients developed fungal infections within the first year after lung transplantation. The most common side effects reported were coughing (75%) and chest tightness (42%). Only one patient had neurological side effect manifested by Jerky movement which led to discontinuation of fungal prophylaxis.
Conclusions: Inhaled amphotericin B can be considered as an option for fungal prophylaxis post lung transplantation with relatively tolerable side effects.
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