1093. Prophylaxis of invasive aspergillosis in lung transplant recipients: is inhaled amphotericin enough?
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Invasive aspergillosis (IA) is an important cause of morbidity and mortality among lung transplant recipients. It is unclear which agent should be used for the prevention of IA in this population. We evaluated the impact of two prophylactic strategies to prevent IA among lung transplant recipients.

Methods: We retrospectively reviewed medical records for all lung transplants performed between 2000 and 2007 at the University of California at San Francisco. Each patient was prescribed one of two fungal prophylactic regimens, a) inhaled prophylaxis only or b) any systemic prophylaxis (e.g. voriconazole) for 12 weeks plus inhaled amphotericin. We performed surveillance bronchoscopies at 2, 4, 6 and 8 weeks post transplantation. We performed brushings, washings and biopsies of suspicious lesions, examined patients and reviewed chest CT scans at the time of bronchoscopies. Using multivariable analyses, we explored the individual impact of either prophylactic strategy (inhaled only versus systemic) on incident IA post transplantation.

Results:  Between October 2000 and May 2007, 251 men and women underwent lung transplantation. Of these, 159 received inhaled while 92 received additional systemic mould prophylaxis . Of those who received inhaled prophylaxis, 17% were diagnosed with IA; 9% of those receiving systemic mould prophylaxis had IA. The median time to the onset of IA was 31 weeks (IQR 14-90). In multivariable analysis, there was a relationship between IA and female sex (OR 4.8, 95% CI 1.6-14, P<0.01), but no evidence for a role of systemic mould prophylaxis (versus inhaled agents only), use of induction agents, age, CMV disease and rejection (P>0.20).

Conclusion: A voriconazole strategy as primary prophylaxis in lung transplant recipients was not associated with a decline in the incidence of IA compared with inhaled amphotericin. Continued surveillance over time is needed to determine whether these effects are sustained and whether the burden of disease due to non Aspergillus mould will increase.

Subject Category: O. Transplant infectious diseases

Seth Cohen, MD1, Barbara Grimes, PhD1, Farnaz Azarbal2, Justin Miyamoto, BA1, Steven Hays, MD3, Jeffrey Golden, MD4 and Peter Chin-Hong, MD2, (1)University of California at San Francisco, San Francisco, CA, (2)Internal Medicine, Division of Infectious Disease, UCSF, San Francisco, CA, (3)California Pacific Medical Center, San Francisco, CA, (4)University of California, San Francisco, CA


S. Cohen, None

B. Grimes, None

F. Azarbal, None

J. Miyamoto, None

S. Hays, None

J. Golden, None

P. Chin-Hong, None

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