Current Infectious Disease Reports

, Volume 15, Issue 6, pp 514–525

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

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

Keywords

Aspergillus Prophylaxis Lung transplant Antimold Antifungal Mold Fungal 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Archana Bhaskaran
    • 1
  • Khalid Mumtaz
    • 2
  • Shahid Husain
    • 1
    • 3
  1. 1.Division of Infectious Diseases and Multi-organ TransplantationUniversity of Toronto, University Health NetworkTorontoCanada
  2. 2.Liver Transplant Program and Multi-organ TransplantationUniversity of Toronto, University Health NetworkTorontoCanada
  3. 3.Multiorgan Transplant Infectious DiseasesUniversity Health Network,University of TorontoTorontoCanada

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