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Anti-Aspergillus Prophylaxis in Lung Transplantation: A Systematic Review and Meta-analysis

  • Transplant and Oncology (M Ison and N Theodoropoulos, Section Editors)
  • Published:
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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.

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Conflict of Interest

Archana Bhaskaran and Khalid Mumtaz declare that they have no conflict of interest.

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

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Infectious Diseases and Multi-organ Transplantation, University of Toronto, University Health Network, Toronto, Ontario, Canada

    Archana Bhaskaran & Shahid Husain

  2. Liver Transplant Program and Multi-organ Transplantation, University of Toronto, University Health Network, Toronto, Ontario, Canada

    Khalid Mumtaz

  3. Multiorgan Transplant Infectious Diseases, University Health Network,University of Toronto, 585 University Avenue, Munk Bldg., 11-C 1206, Toronto, ON, M5G 2C4, Canada

    Shahid Husain

Authors
  1. Archana Bhaskaran
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  2. Khalid Mumtaz
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Correspondence to Shahid Husain.

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Bhaskaran, A., Mumtaz, K. & Husain, S. Anti-Aspergillus Prophylaxis in Lung Transplantation: A Systematic Review and Meta-analysis. Curr Infect Dis Rep 15, 514–525 (2013). https://doi.org/10.1007/s11908-013-0380-y

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  • DOI: https://doi.org/10.1007/s11908-013-0380-y

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