Influence of Extended Itraconazole Antifungal Prophylaxis on the Development of Fungal Infections After Lung...

Invasive fungal infections (IFIs) are associated with a high mortality in lung transplant recipients, with no consensus on optimal antifungal prophylaxis. We aimed to assess the efficacy of long-term itraconazole compared to short-term inhaled amphotericin to prevent IFIs post-transplant.

A retrospective review of adult lung transplant recipients from January 2016 to September 2022 was conducted. The cohort was divided into two groups based on initial mold prophylaxis: long-term itraconazole and short-term inhaled amphotericin. The primary outcome was the incidence of IFIs. The secondary outcomes included the time to IFI, incidence of fungal species found on cultures, and safety/tolerability.

A total of 203 patients met the inclusion criteria (amphotericin group n = 108, itraconazole group n = 95). The overall incidence of IFIs was significantly higher in the amphotericin group than the itraconazole group (76.9% vs. 56.8%, p = 0.002). The Kaplan-Meier curve for the risk of IFI within 1 year of transplant showed a shorter time to IFI in the amphotericin group (p = 0.009). In the amphotericin group, there was an increased incidence of positive fungal cultures compared to the itraconazole group with Aspergillus spp. (25% vs. 8.4%, p = 0.002), Penicillium spp. (25.9% vs. 9.5%, p = 0.002), yeast (70.4% vs. 36.8%, p ≤ 0.001), and other positive fungal cultures (28.7% vs. 12.6%, respectively, p = 0.005). The amphotericin group had more discontinuations due to intolerance than the itraconazole group (12% vs. 3.2%, p = 0.019).

In adult lung transplant recipients, long-term prophylaxis with itraconazole was more effective at preventing overall IFIs, positive cultures with Aspergillus spp., and was better tolerated than short-term inhaled amphotericin.