Anti-Fungal Prophylaxis in Pediatric Lung Transplantation – An International Multi-Center Survey

Abstract

Purpose Fungal infections pose a significant risk to children following lung transplantation. However, there are at present no internationally agreed upon guidelines for anti-fungal prophylaxis, and current clinical practice varies. The aim of this survey was to ascertain the current strategies of anti-fungal prophylaxis of pediatric lung transplant centers. Methods and Materials In 2012, nominated clinicians at each of the 24 centers within the International Pediatric Lung Transplant Collaborative (IPLTC) were invited to participate in a web-based, self-administered survey on strategies of anti-fungal prophylaxis adopted at their institution. Responders were asked to complete the survey via a combination of multiple choice and free text answers. Results 19 (79%) centers responded to the survey. Centers were predominantly located in the US and Europe, >50% of centers perform pediatric and adult lung transplants. The majority of centers (78%) routinely use pre-emptive/targeted prophylaxis, mainly in patients with pre-transplant fungal colonization. Commonly, institutions aim to target Aspergillus and Candida infection, whilst most choose to use monotherapy, mainly voriconazole or inhaled amphotericine B. Centers employ prophylaxis for variable amounts of time (42% ≤3 months, 42% for ≥12 months). The reasons to change to alternative drugs were intolerability, toxicity or positive surveillance culture. 88% of centers utilize therapeutic drug monitoring. Conclusions This survey has identified a wide range of anti-fungal prophylaxis strategies adopted internationally in the pediatric lung transplant population. There is growing approval for the formation of internationally agreed upon guidelines within the pediatric lung transplant community.