Posaconazole in lung transplant recipients: use, tolerability, and efficacy

Area of Science:

• Medical Mycology
• Transplant Infectious Diseases
• Pharmacology

Background:

• Fungal infections pose significant risks to lung transplant recipients (LuTR), leading to mortality and morbidity.
• Resistance and intolerance to first-line antifungals are increasing challenges in LuTR care.
• Posaconazole (PCZ), a triazole antifungal, presents a promising alternative treatment option.

Purpose of the Study:

• To evaluate the use, tolerability, efficacy, and drug interactions of oral posaconazole suspension in lung transplant recipients.
• To assess the impact of posaconazole on tacrolimus levels in LuTR.

Main Methods:

• A single-center retrospective study was conducted.
• Seventy-eight lung transplant recipients received posaconazole oral suspension for prophylaxis, pre-emptive treatment, or treatment of invasive fungal infections.
• Data on efficacy, tolerability, and drug interactions with tacrolimus were collected and analyzed.

Main Results:

• Posaconazole demonstrated efficacy, with resolution observed in 52.4% of patients in the probable, possible, and pre-emptive treatment groups.
• The drug was generally well-tolerated, with 11.5% of patients experiencing adverse effects.
• 11.7% of patients on concurrent tacrolimus experienced supratherapeutic levels, necessitating careful monitoring.

Conclusions:

• Posaconazole is a well-tolerated and effective agent for managing fungal infections post-lung transplantation.
• Close therapeutic drug monitoring of tacrolimus is essential for LuTR receiving concurrent posaconazole therapy to mitigate risks of supratherapeutic levels and potential renal complications.