Discontinuation of Anti-Fungal Prophylaxis in Lung Transplant Recipients: Why Does It Happen

Abstract

Purpose The objective of this study was to review the reasons lung transplant recipients discontinue antifungal prophylaxis, as documented by treating physicians. Methods We retrospectively reviewed patients who received a single or double lung transplant at Mayo Clinic Rochester from 2002 to 2010 examining the type of antifungal medication and reasons for discontinuation. Lung transplant recipients at our institution receive triazole therapy, voriconazole or itraconazole, for prevention of invasive fungal infections. Results We identified 102 patients who underwent lung transplant at Mayo Clinic from 2002 to 2010; 11 patients died within 6 months of transplant and were excluded. Of the 91 patients who survived longer than 6 months post lung transplant: 86 received itraconazole, 44 received voriconazole, and 37 received both (Table 1). A significantly higher proportion of patients discontinued voriconazole than itraconazole [31 out of 44 (70.5%) versus 41 out of 86 (47.6%), p=0.01]. Side effects (gastrointestinal intolerance, hepatitis, and fluorosis) were the most common reason for discontinuing voriconazole [20/44 (45.5)] compared to one of the least common reasons itraconazole was discontinued [6/86 (8.4), p Conclusion Itraconazole was discontinued prior to the prophylactic end point significantly less often than voriconazole and appeared to be better tolerated; although, several patients were diagnosed with an invasive fungal infection while on itraconazole prophylaxis.