VORICONAZOLE PROPHYLAXIS IN LUNG TRANSPLANT RECIPIENTS (LT) IS ASSOCIATED WITH DELAYED-ONSET FUNGAL PNEUMONIA AND LOW RATES OF MORTALITY AND EXTRA-PULMONARY DISSEMINATION

A. Vadnerkar1, U. Celik1, C. Clancy1, D. Mitsani1, M. Nguyen1*

Author address: 

1University of Pittsburgh

Abstract: 

Purpose: Invasive aspergillosis (IA) and other fungal infections (IFI) are significant problems in LT recipients. Alemtuzumab, an anti-CD52 monoclonal antibody that causes profound lymphopenia and potentially increases risk of IFI, has been standard induction therapy at our center since 2003. Voriconazole is given as anti-fungal prophylaxis. Methods: Retrospective review of 304 consecutive patients who underwent LT or heart-LT and received alemtuzumab induction and voriconazole prophylaxis from Jan 2005 Dec 2007. Voriconazole was given as 6mg/kg IV load x 2 followed by 200mg BID for ≥ 3 months. Results: The median duration of voriconazole prophylaxis was 6 months. 65% (197/304) of patients were colonized with fungi on ≥ 1 occasion. 18% (56) developed ≥ 1 IFI, including 17% (52) with pulmonary disease and 1% (4) with extra-pulmonary. 51% of IFI were pneumonias, and 39% were tracheobronchitis. 88% of tracheobronchitis occurred while patients were receiving voriconazole prophylaxis, and 62% were caused by yeasts. 56% of pneumonias occurred after the completion of prophylaxis, including cases as late as 3 years following LT. 68% of pneumonias were caused by moulds, 59% of which were due to Aspergillus spp. 63% of voriconazole-breakthrough pneumonias caused by moulds were due to non-Aspergillus spp., including 32% due to moulds typically susceptible to voriconazole and 31% due to frequently resistant moulds like Mucor, Rhizopus and Scedosporium. 92% of post-prophylaxis pneumonias caused by moulds were due to Aspergillus. Significant independent risk factors for IFI were re-transplant for obliterative bronchiolitis (p
2010

abstract No: 

72

Full conference title: 

4th Advances Against Aspergillosis
    • AAA 4th (2010)