Antifungal Prophylaxis in Lung Transplant Recipients: A Network Meta-Analysis

Abstract

Purpose Invasive fungal infections (IFIs), in particular invasive aspergillosis cause significant morbidity and mortality in lung transplant recipients (LTRs). Various antifungal agents are used either for universal or pre-emptive/ targeted prophylaxis. However, as there is a lack of randomized control studies, the best agent for prophylaxis/ pre-emptive treatment remains unknown. Methods We identified studies comparing regimens for antifungal prophylaxis in LTRs. We ran a frequentist network (Figure 1). We checked for inconsistency in the network. We could not reject the null hypothesis that the model was consistent between the direct and indirect estimates. Therefore, the model was run under the consistency assumption. Results Ten observational studies were included, which reported comparisons of liposomal amphotericin B (L-AmB), itraconazole, voriconazole, isavuconazole and no treatment. Amphotericin B was the best agent for reducing the rate of IFI in the network meta-analysis, followed by isavuconazole and voriconazole respectively (Table 1). Conclusion Our network analysis suggests that L-AmB and isavuconazole are the preferred antifungal agents for reducing IFI in LTRs.