Utility of BAL Galactomannan (GM) and Culture Based Pre-Emptive Antifungal Therapy (PET) Strategy in Lung Transplant Recipients (LTRs)

Ref ID: 18672

Author:

S. Husain, MD – Associate Professor of Medicine, L. Singer, MD – Medical Director, Toronto Lung Transplant Program, Y. Akinlolu, MSc – Clinical Research Coordinator, C. Chaparro, MD – Assistant Professor of Medicine, C. Rotstein, MD – Professor of Me

Author address:

Univ. Hlth. Network, Toronto, Canada.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: LTRs have the highest incidence of Invasive Aspergillosis (IA) among solid organ transplant recipients. This higher rate has prompted the adoption of a universal antifungal prophylaxis approach in most of the lung transplant centers around the world. We assessed the utility of PET based on the incorporation of BAL GM and culture methods for the initiation of antifungal therapy. Methods: We evaluated 91 consecutive LTRs since January 2010 with at least 12 months of follow-up. Antifungal PET was instituted if the patients were known to be colonized with Aspergillus (ASP) prior to transplantation, had positive GM or positive culture for ASP at time of bronchoscopy during the first year of transplant. EORTC/MSG/ISHLT criteria were used to define the type of invasive fungal infections. Results: A total of 399 BALs were performed in these patients. The distribution of positive and negative GM samples and invasive fugal syndromes are shown below: A total of 51 (PretxASP col, 14; GM+, 31; PosttxASP culture+, 6) patients received PET with antimold agents. No cases of IA were identified in patients who did not satisfy PET criteria. Conclusions: PET based on the synergistic use of BAL GM and culture in LTRs during the first year decreased the use of anti-fungal therapy by 43% without missing any cases of IA.

Abstract Number: T-1067

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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