Risk Factors and Rates of Fungal Infection in Lung Transplant Recipients Who Receive Posaconazole and Inhaled Amphotericin Combination Prophylaxis Therapy

Abstract

PurposeFungal prophylaxis is recommended after lung transplantation (LT) to prevent anastomotic complications and invasive fungal infections. The optimal regimen is unknown and the incidence of and risk factors for fungal colonization and infection are incompletely understood.MethodsWe performed a single-center, retrospective cohort study of subjects who underwent LT between 12/1/2015 and 12/31/2019. Per protocol, subjects received 2 months of posaconazole (posa) and inhaled amphotericin (IA) after LT. Surveillance bronchoscopy was performed at 2 weeks, 1-month (mo), 2-mo, 3-mo, 6-mo, and 12-mo after LT. Bronchoalveolar lavage microbiology data and CT imaging were reviewed to identify incidence of fungal colonization and infection (defined as tracheobronchitis or invasive fungal infection) within 1 year after LT. We calculated incidence rates (IR) for fungal colonization and infection. We used univariate logistic regression to test selected potential predictors for fungal colonization and infection.ResultsTwo hundred thirty-six subjects underwent LT during the study period and 54 had a positive fungal culture within the first year. The IR of positive fungal culture was 0.29/person-year, fungal colonization 0.19/person-year, and fungal infection 0.1/person-year. Aspergillus spp (n = 49, 90.7%) was most common. Mean age was 58.2 ± 10.3 years versus 57.4 ± 12.7 years among all LT recipients (p = 0.67). Latinx subjects were 2.9 times more likely to have a positive fungal culture than non-Latinx subjects (95% CI 1.41-5.9) (Table 1). There was no association between gender or LT indication and likelihood of positive culture (Table 1).ConclusionRates of fungal colonization and infection within 1 year after LT were low using a combined regimen of 2 months of posa and IA. Latinx LT recipients had a higher likelihood of positive fungal culture. Further research is needed to understand possible environmental contributors to this finding. Fungal prophylaxis is recommended after lung transplantation (LT) to prevent anastomotic complications and invasive fungal infections. The optimal regimen is unknown and the incidence of and risk factors for fungal colonization and infection are incompletely understood. We performed a single-center, retrospective cohort study of subjects who underwent LT between 12/1/2015 and 12/31/2019. Per protocol, subjects received 2 months of posaconazole (posa) and inhaled amphotericin (IA) after LT. Surveillance bronchoscopy was performed at 2 weeks, 1-month (mo), 2-mo, 3-mo, 6-mo, and 12-mo after LT. Bronchoalveolar lavage microbiology data and CT imaging were reviewed to identify incidence of fungal colonization and infection (defined as tracheobronchitis or invasive fungal infection) within 1 year after LT. We calculated incidence rates (IR) for fungal colonization and infection. We used univariate logistic regression to test selected potential predictors for fungal colonization and infection. Two hundred thirty-six subjects underwent LT during the study period and 54 had a positive fungal culture within the first year. The IR of positive fungal culture was 0.29/person-year, fungal colonization 0.19/person-year, and fungal infection 0.1/person-year. Aspergillus spp (n = 49, 90.7%) was most common. Mean age was 58.2 ± 10.3 years versus 57.4 ± 12.7 years among all LT recipients (p = 0.67). Latinx subjects were 2.9 times more likely to have a positive fungal culture than non-Latinx subjects (95% CI 1.41-5.9) (Table 1). There was no association between gender or LT indication and likelihood of positive culture (Table 1). Rates of fungal colonization and infection within 1 year after LT were low using a combined regimen of 2 months of posa and IA. Latinx LT recipients had a higher likelihood of positive fungal culture. Further research is needed to understand possible environmental contributors to this finding.