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Breakthrough Mold Infections During Long-term Nebulized Liposomal Amphotericin B Prophylaxis in Lung Transplant

Arnau Monforte1,2, Ibai Los-Arcos1,2,3, Maria Teresa Martín-Gómez4

  • 1Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.

Transplantation
|April 8, 2026
PubMed
Abstract

Insights

Lifelong nebulized liposomal amphotericin B (n-LAB) prophylaxis effectively reduced breakthrough mold infections in lung transplant recipients (LTRs). This antifungal strategy demonstrated good tolerability and did not increase mortality, even with resistant mold strains.

Area of Science:

  • Medical Mycology
  • Transplant Surgery
  • Infectious Diseases

Background:

  • Fungal infections, particularly Aspergillus and other molds, are prevalent in lung transplant recipients (LTRs).
  • No standardized antifungal preventive strategy currently exists for LTRs.
  • Lifelong nebulized liposomal amphotericin B (n-LAB) has been utilized as a prophylactic measure at our institution.

Purpose of the Study:

  • To evaluate the efficacy of lifelong n-LAB prophylaxis in preventing breakthrough mold infections (b-MIs) in LTRs.
  • To assess the tolerability and safety profile of n-LAB prophylaxis in this patient population.
  • To identify risk factors associated with b-MIs post-lung transplantation.

Main Methods:

  • An observational retrospective study was conducted on adult LTRs receiving n-LAB prophylaxis from August 2013 to March 2023.
  • Participants were monitored for at least one year post-transplant or until death.
  • Only proven or probable mold infections occurring during n-LAB exposure were analyzed.

Main Results:

  • The incidence of b-MI within the first year post-transplant was 8.7%, with 11.7% of LTRs developing b-MI over a median follow-up of 2.56 years.
  • Independent risk factors for b-MI included bronchial stenosis, bronchial stent placement, and single lung transplant.
  • n-LAB prophylaxis was well-tolerated, with only 2.2% discontinuing due to adverse events. Mold colonization and b-MI were significantly associated with increased mortality.

Conclusions:

  • Lifelong n-LAB prophylaxis is associated with a low incidence of mold infections in LTRs during extended follow-up.
  • The n-LAB regimen demonstrated excellent tolerability.
  • The emergence of amphotericin B-nonsusceptible molds did not correlate with increased mortality in this cohort.

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