Anti-Fungal Prophylaxis in Lung Transplant Recipients (LTRs): A Meta-Analysis of Cohort Studies

Abstract

Purpose Majority of lung transplant centers have adopted antifungal prophylaxis directed against Aspergillus (Asp) species based on single center cohort studies. We performed a meta-analysis to determine whether current antifungal prophylaxis strategies decrease the rate of invasive aspergillosis (IA) or Asp. colonization in LTRs. Methods and Materials The search was carried out on MEDLINE (1990-Oct 2012), EMBASE (1990-Oct 2012). For dichotomous outcomes, relative risks (RR) with 95% confidence intervals (CI) were calculated for individual studies and the summary statistics were calculated using a Random effects model (Review Manager [RevMan] Version 5.0, The Nordic Cochrane Centre, The Cochrane Collaboration, 2008). Results Of 323 references retrieved, 16 retrospective cohort studies were identified. Out of these, 8 studies had sufficient information of the comparator for the meta-analysis. These studies included a total of 1,009 LTRs. Antifungal prophylaxis significantly reduced the IA (RR, 0.45; CI, 0.21-0.97) while there was no significant effect on Asp. colonization (RR, 0.82; CI, 0.56-1.20). Antifungal prophylaxis with inhaled-Amphotericin (including lipid preparation) (3 studies), (RR, 0.47; CI, 0.18-1.22) and azoles (6 studies) (RR, 0.42; CI, 0.12-1.52) didn’t show statistically significant risk reduction. Rate of Discontinuation, cough, SOB, nausea and hepatotoxicity was not statistically significant among different antifungals. Conclusions Overall antifungal prophylaxis decreases the rate of IA however, has no effect on the Asp. colonization in LTRs. A randomized controlled trial to assess the efficacy of antifungal prophylaxis is warranted.