An evaluation of caspofungin treatment of invasive fungal infections in solid organ transplant patients

Invasive fungal infections are a significant factor in causing death in solid organ transplant recipients, particularly following lung or liver transplantation. Amphotericin B was the only drug available for transplant patients with post-invasive fungal infections for many years, and was often used to treat these patients despite the risks of kidney damage and liver failure.

In this report ( see Transplantation Infectious Disease) by Winkler et al, the antifungal drug caspofungin was evaluated as a post-transplant antifungal treatment in patients undergoing solid organ transplants – who then went on to develop an invasive fungal infection.
Caspofungin has not shown significant drug-to-drug interactions involving the metabolism of immuno suppressive drugs – which are necessary in transplant patients. This was significant in this report as 9 patients were switched to caspofungin therapy as a result of another antifungal interaction with their immunosuppressive treatment.
A total of 81 patients were included in this observational study from 4 countries, with various types of solid organ transplantation. Candidiasis was diagnosed in 64/81 patients (79%) and aspergillosis in 22/81 patients (27%). Most patients received caspofungin monotherapy (75%).

Caspofungin was effective as first- and second-line therapy in this group of patients with a favorable response rate of 87% in transplant recipients with proven or probable invasive fungal infections. It was noteworthy that 89% of patients with proven or probable invasive Candida infection and 74% of patients with proven or probable Aspergillus infection responded to caspofungin treatment, consistent with results reporting that caspofungin was an effective treatment in invasive aspergillosis after thoracic transplantations.

The authors point out that there are limitations to the conclusions of this study – particularly as there is a lack of any possible control study and the small numbers – however the use of caspofungin looks promising – for the treatment of invasive infection relating to solid organ transplants.
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