Anti-aspergillus prophylaxis in lung transplantation: A systematic review and meta-analysis

Archana Bhaskaran, Khalid Mumtaz, Shahid Husain

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Aspergillus is the most common cause of invasive fungal infection in lung transplant recipients. Most transplant centers employ routine antifungal prophylaxis to prevent the development of invasive aspergillosis (IA). We identified 22 studies from the literature to perform a systematic review and meta-analysis, in order to assess the development of IA and Aspergillus colonization with and without antifungal prophylaxis. Similarly, differences in the toxicities of different formulations of amphotericin-B and azoles were analyzed. Nineteen of 235 (8.1 %) and 28 of 196 (14.3 %) developed IA in the universal prophylaxis and no-prophylaxis arms, respectively (RR: 0.36, CI: 0.05-2.62). We did not find a significant reduction in IA or Aspergillus colonization with universal anti-aspergillus prophylaxis. There was no difference in the adverse events of inhaled amphotericin-B deoxycholate and lipid formulations of inhaled amphotericin-B. However, voriconazole was more hepatotoxic than itraconazole. These results should be interpreted with caution due to heterogeneity of the studies. A multicenter randomized controlled trial is warranted to assess the efficacy of anti-aspergillus prophylaxis in lung transplant recipients.

Original languageEnglish (US)
Pages (from-to)514-525
Number of pages12
JournalCurrent Infectious Disease Reports
Volume15
Issue number6
DOIs
StatePublished - Dec 2013

Bibliographical note

Funding Information:
Shahid Husain has received grants from Pfizer, Astellas and Merck.

Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.

Keywords

  • Antifungal
  • Antimold
  • Aspergillus
  • Fungal
  • Lung transplant
  • Mold
  • Prophylaxis

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