Incidence of invasive fungal infections following aerosolized amphotericin B lipid complex as sole prophylaxis in adult lung transplant recipients

Purpose: To determine the incidence of invasive fungal infections (IFIs) at 30 and 90 days post-operatively in adult lung transplant recipients receiving aerosolized amphotericin B lipid complex (aABLC) as the sole antifungal prophylaxis.  Prophylaxis-limiting adverse events related to aABLC were also described.

Methods: This was a retrospective, single-center cohort study conducted in patients ≥ 18 yrs of age undergoing lung transplant at Duke University Hospital between 1/1/08 and 12/31/10 and receiving at least one dose of aABLC as the sole fungal prophylaxis.  Retransplant within 90 days, receipt of concomitant systemic antifungals or alemtuzumab, active IFI at transplant, and those with incomplete medical records were excluded.  Patient demographics, IFI criteria, antifungal use, and aABLC treatment descriptions were collected.  Probable or definite IFI were determined using MSG/EORTC definitions.

Results: 243 subjects were evaluable.  Most were Caucasian (86%) and male (64%), with a mean age of 56 years (range 18-78 years).  Most received a bilateral-lung transplant (77.4%), most frequently due to idiopathic pulmonary fibrosis (~50%).  Antifungal use for empiric or documented IFIs was common (35.8%).  Probable or definite IFI at 30 and 90 days occurred in 29 (11.9%) and 44 (18.1%) patients, respectively.  Of these, 34.8% and 46.7% were caused by Candida spp and 24.3% and 20% were caused by Aspergillus  spp, respectively.  While aABLC was prematurely discontinued in 7 (2.9%) subjects, only one (0.4%) was due to intolerance.

Conclusion: Use of aABLC as sole prophylaxis was associated with rates of IFI in the early post-transplant period comparable to other strategies.  Rates of invasive aspergillosis were low.   Patients receiving aABLC were unlikely to experience intolerance leading to discontinuation of therapy.