The use of antifungal prophylaxis, targeted or universal, remains controversial and unstudied. The goal of this study is to determine the role of targeted voriconazole prophylaxis (VORI) in prevention of invasive fungal infections (IFI) after heart transplantation (HT).
We conducted a single-center, prospective, observational cohort study of 276 HT recipients from 6/2005-4/2017 to characterize the incidence and outcome of IFI following targeted VORI. Starting in 6/2013, HT recipients with thymoglobulin (ATG) treatment received VORI for 3 months. Probable/proven IFI were defined by EORTC/MSG criteria. Descriptive frequencies and univariate analyses were performed.
Mean duration of follow up post-HT was 1165 d (0-3152 d). 149 (54%) and 70 (25%) received basiliximab and thymoglobulin induction, respectively. 31 (11%) received VORI, following use of ATG in the setting of induction (68%) or rejection (32%). VORI was started at median of 6 d (0 - 1008 d) post HT for a mean duration of 97 d (5 - 251 d).
Overall, 23 IFIs occurred in 23 recipients (8%) at mean 283 d post HT (range 2-1579 d), including 7 Aspergillus (1 occurring after VORI completion), 7 invasive Candida (5 with candidemia), 2 Rhizopus, 1 Cunninghamella, 2 Histoplasma, 2 Blastomyces, 1 Cryptococcus and 1 multifocal cutaneous Alternaria.
Targeted VORI resulted in reduced incidences of both early and overall IFI after HT although this did not reach statistical significance. Since instituting this strategy, we have observed a single case of aspergillosis following VORI discontinuation. Overall and 1-yr mortality were not impacted. The use of antifungal prophylaxis following HT requires continued investigation both to determine efficacy and toxicity in this patient population.
M. Angarone, None
A. Anderson, None
V. Stosor, None