Efficacy and Tolerance of Different Types of Prophylaxis for Prevention of Early Aspergillosis After Heart Transplantation

Abstract

Background The incidence of aspergillosis (ASP) after heart transplantation (HTx) is low (<4%–5%), but the mortality is high (>78%). Aim To determine the incidence of ASP in the first 3 months post-HTx according to the type of prophylaxis and assess the tolerance to these regimens. Methods This retrospective study of 571 adult HTx patients engrafted from 1991 to December 2009 included 83% males with an overall group age of 54.9 ± 11 years. Three types of prophylaxis were compared: group A was no prophylaxis ( n = 99; 1991–1994); group B, itraconazole for 3 months ( n = 352; 1995–November 2004); and group C, inhaled amphotericin for 3 months ( n = 120; December 2004–2009). The dependent variables were the presence and severity or tracheobronchitis and invasive/disseminated disease as well as, prognosis of Aspergillus infection and tolerance to the regimen. Results The incidences of aspergillosis were 5% in group A ( n = 5); 1.4% in group B ( n = 5); and 0% in group C. Significant differences were observed between groups A versus B ( P = .030) and between groups A versus C ( P = .013), but there were no differences between groups B versus C. In terms of severity, there were no significant differences among the five cases of tracheobronchitis (20% group A/80% group B), five of invasive/disseminated disease (80% group A /20% group B). There were two deaths (20%) from invasive/disseminated ASP at 0.67 months after diagnosis. The mean time from HTx to ASP was 0.98 ± 0.40 months. There were no adverse effects associated with itraconazole, but they occurred in 3/120 patients (2.5%) treated with inhaled amphotericin, all of whom were on mechanical ventilation, developing respiratory failure requiring amphotericin withdrawal. Conclusions Prophylaxis with itraconazole or inhaled amphotericin was effective for the prevention and severity of pulmonary ASP in the first 3 months post-HTx. Although the incidence of early ASP was low in our series, the 20% mortality rate justified the use of preventive measures. Tolerance to both prophylactic treatments was good.