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Antifungal prophylaxis with voriconazole or itraconazole in lung transplant recipients: hepatotoxicity and

J Cadena1, D J Levine, L F Angel

  • 1Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center at San Antonio (UTHSCSA), TX, USA. cadenazuluag@uthscsa.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|August 4, 2009
PubMed

Insights

Itraconazole prophylaxis is safer than voriconazole for lung transplant recipients, showing similar effectiveness against invasive fungal infections (IFI) but with less liver toxicity. This study compares azole regimens for IFI prevention.

Area of Science:

  • Medical Mycology
  • Transplantation Medicine
  • Pharmacology

Background:

  • Invasive fungal infections (IFI) pose a significant risk post-lung transplantation.
  • Limited data exist on the efficacy and safety of antifungal prophylaxis in this patient population.
  • Azole antifungals are commonly used for prophylaxis, but comparative safety data are scarce.

Purpose of the Study:

  • To compare the safety and effectiveness of two azole antifungal regimens for universal prophylaxis in lung transplant recipients.
  • To evaluate the incidence of hepatotoxicity between itraconazole and voriconazole when used with inhaled amphotericin B.

Main Methods:

  • Retrospective study of 67 lung transplant recipients receiving antifungal prophylaxis between July 2003 and July 2006.
  • Patients received either itraconazole or voriconazole, both in combination with inhaled amphotericin B.
  • Primary outcome: incidence of hepatotoxicity; Secondary outcomes: incidence of IFI, clinical outcomes, and mortality.

Main Results:

  • Hepatotoxicity occurred in 12 patients on voriconazole plus inhaled amphotericin B, versus none on itraconazole (p < 0.001).
  • No significant difference in the incidence of IFI between the two groups.
  • One case of zygomycosis was observed in the voriconazole group.

Conclusions:

  • Voriconazole prophylaxis in lung transplant recipients is associated with a higher incidence of hepatotoxicity compared to itraconazole.
  • Both regimens demonstrated similar clinical effectiveness in preventing invasive fungal infections.
  • Itraconazole may be a safer alternative for antifungal prophylaxis in lung transplant patients.

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