Antifungal prophylaxis in lung transplant

A survey of United States' transplant centers

Research output: Contribution to journalArticle

Abstract

Background: Antifungal prophylaxis strategies for lung transplant recipients vary without consensus or standard of care. Our current study aims to identify antifungal prophylaxis practices in the United States. Methods: From November 29, 2018, to February 15, 2019, we emailed surveys to medical directors of adult lung transplant centers. An alternate physician representative was approached if continued non-response after three survey attempts. Descriptive statistics were used to report findings. Results: Forty-four of 62 (71.0%) eligible centers responded. All Organ Procurement and Transplantation Networks were represented. Only four (9.1%) centers used pre-transplant prophylaxis for prevention of tracheobronchitis (3 of 4) and invasive fungal disease (4 of 4). Thirty-nine of forty (97.5%) centers used post-transplant prophylaxis: 36 (90.0%) universal and 3 (7.5%) pre-emptive/selective prophylaxis. Most centers used nebulized amphotericin with a systemic agent (26 of 36, 72.2%). Thirty-two of thirty-six (88.9%) centers continued universal prophylaxis beyond the hospital setting. Duration of prophylaxis ranged from the post-transplant hospitalization to lifelong with most centers (25 of 36, 69.4%) discontinuing prophylaxis 6 months or less post-transplant. Conclusion: Most United States' lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for 6 months or less post-transplant. Very few centers use pre-transplant antifungal prophylaxis.

Original languageEnglish (US)
Article numbere13630
JournalClinical Transplantation
DOIs
StatePublished - Jan 1 2019

Fingerprint

Transplants
Lung
Amphotericin B
Physician Executives
Tissue and Organ Procurement
Triazoles
Surveys and Questionnaires
Mycoses
Organ Transplantation
Standard of Care
Hospitalization
Physicians

Keywords

  • antifungal prophylaxis
  • Aspergillus
  • azole
  • fungal infections
  • lung transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{cf3790e0bd534b54ae59c261cedee937,
title = "Antifungal prophylaxis in lung transplant: A survey of United States' transplant centers",
abstract = "Background: Antifungal prophylaxis strategies for lung transplant recipients vary without consensus or standard of care. Our current study aims to identify antifungal prophylaxis practices in the United States. Methods: From November 29, 2018, to February 15, 2019, we emailed surveys to medical directors of adult lung transplant centers. An alternate physician representative was approached if continued non-response after three survey attempts. Descriptive statistics were used to report findings. Results: Forty-four of 62 (71.0{\%}) eligible centers responded. All Organ Procurement and Transplantation Networks were represented. Only four (9.1{\%}) centers used pre-transplant prophylaxis for prevention of tracheobronchitis (3 of 4) and invasive fungal disease (4 of 4). Thirty-nine of forty (97.5{\%}) centers used post-transplant prophylaxis: 36 (90.0{\%}) universal and 3 (7.5{\%}) pre-emptive/selective prophylaxis. Most centers used nebulized amphotericin with a systemic agent (26 of 36, 72.2{\%}). Thirty-two of thirty-six (88.9{\%}) centers continued universal prophylaxis beyond the hospital setting. Duration of prophylaxis ranged from the post-transplant hospitalization to lifelong with most centers (25 of 36, 69.4{\%}) discontinuing prophylaxis 6 months or less post-transplant. Conclusion: Most United States' lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for 6 months or less post-transplant. Very few centers use pre-transplant antifungal prophylaxis.",
keywords = "antifungal prophylaxis, Aspergillus, azole, fungal infections, lung transplant",
author = "Pennington, {Kelly M.} and Yost, {Kathleen J} and Patricio Escalante and Razonable, {Raymund R} and Cassie Kennedy",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/ctr.13630",
language = "English (US)",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Antifungal prophylaxis in lung transplant

T2 - A survey of United States' transplant centers

AU - Pennington, Kelly M.

AU - Yost, Kathleen J

AU - Escalante, Patricio

AU - Razonable, Raymund R

AU - Kennedy, Cassie

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Antifungal prophylaxis strategies for lung transplant recipients vary without consensus or standard of care. Our current study aims to identify antifungal prophylaxis practices in the United States. Methods: From November 29, 2018, to February 15, 2019, we emailed surveys to medical directors of adult lung transplant centers. An alternate physician representative was approached if continued non-response after three survey attempts. Descriptive statistics were used to report findings. Results: Forty-four of 62 (71.0%) eligible centers responded. All Organ Procurement and Transplantation Networks were represented. Only four (9.1%) centers used pre-transplant prophylaxis for prevention of tracheobronchitis (3 of 4) and invasive fungal disease (4 of 4). Thirty-nine of forty (97.5%) centers used post-transplant prophylaxis: 36 (90.0%) universal and 3 (7.5%) pre-emptive/selective prophylaxis. Most centers used nebulized amphotericin with a systemic agent (26 of 36, 72.2%). Thirty-two of thirty-six (88.9%) centers continued universal prophylaxis beyond the hospital setting. Duration of prophylaxis ranged from the post-transplant hospitalization to lifelong with most centers (25 of 36, 69.4%) discontinuing prophylaxis 6 months or less post-transplant. Conclusion: Most United States' lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for 6 months or less post-transplant. Very few centers use pre-transplant antifungal prophylaxis.

AB - Background: Antifungal prophylaxis strategies for lung transplant recipients vary without consensus or standard of care. Our current study aims to identify antifungal prophylaxis practices in the United States. Methods: From November 29, 2018, to February 15, 2019, we emailed surveys to medical directors of adult lung transplant centers. An alternate physician representative was approached if continued non-response after three survey attempts. Descriptive statistics were used to report findings. Results: Forty-four of 62 (71.0%) eligible centers responded. All Organ Procurement and Transplantation Networks were represented. Only four (9.1%) centers used pre-transplant prophylaxis for prevention of tracheobronchitis (3 of 4) and invasive fungal disease (4 of 4). Thirty-nine of forty (97.5%) centers used post-transplant prophylaxis: 36 (90.0%) universal and 3 (7.5%) pre-emptive/selective prophylaxis. Most centers used nebulized amphotericin with a systemic agent (26 of 36, 72.2%). Thirty-two of thirty-six (88.9%) centers continued universal prophylaxis beyond the hospital setting. Duration of prophylaxis ranged from the post-transplant hospitalization to lifelong with most centers (25 of 36, 69.4%) discontinuing prophylaxis 6 months or less post-transplant. Conclusion: Most United States' lung transplant centers utilize a universal prophylaxis with nebulized amphotericin and a systemic triazole for 6 months or less post-transplant. Very few centers use pre-transplant antifungal prophylaxis.

KW - antifungal prophylaxis

KW - Aspergillus

KW - azole

KW - fungal infections

KW - lung transplant

UR - http://www.scopus.com/inward/record.url?scp=85068061717&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068061717&partnerID=8YFLogxK

U2 - 10.1111/ctr.13630

DO - 10.1111/ctr.13630

M3 - Article

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

M1 - e13630

ER -