Pre-emptive/targeted prophylaxis with voriconazole in lung transplant patients: a retrospective cohort study

Ref ID: 17696

Author:

C.F. Neoh, G. Snell, B. Levvey, T. Kotsimbos, O. Morrissey, M. Slavin,
K. Stewart, D. Kong*

Author address:

(Melbourne, AU)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Objective: Invasive fungal infection is one of the major complications,
contributing to high mortality and morbidity among lung transplant
(LTx) patients. Data for voriconazole use in pre-emptive/targeted
prophylactic setting remain scant. This study aimed to investigate the
efficacy and safety of voriconazole pre-emptive/targeted prophylaxis
among LTx patients once airway fungal colonisation was confirmed.
Methods: A retrospective, single-centre, observational cohort study
was conducted. All adult LTx patients who received voriconazole preemptive/
targeted prophylaxis for the first time between July 2003 and
June 2010 were followed up for 1 year. Outcomes were determined at
6 months (primary end-point) and at 12 months after initiation of
voriconazole prophylaxis. Chi-square test was used to assess the
relationships between variables and outcomes (i.e. fungal infection,
Aspergillus colonisation, death and drug-related hepatotoxicity).
Cumulative survival rate at 12-month after initiation of prophylaxis
were estimated using the Kaplan-Meier method.
Results: A total of 62 LTx patients were included. A. fumigatus
(75.8%) was the most common colonising isolate. Median duration of
voriconazole prophylaxis was 84 days. At the 6-month end-point, one
(1.6%) had developed probable fungal pneumonia, 48 (77.5%) had
successful eradication of colonisation, three (4.8%) had persistent
colonisation, six (9.7%) had recurrent colonisation, two (3.2%) had
aspergilloma and two (3.2%) were clinically unstable but no culture
was performed. Sixteen (25.8%) had died by the 12-month end-point,
half due to Bronchiolitis Obliterans Syndrome. Ten (16.1%) had drugrelated
hepatotoxicity. Patients with diabetes mellitus within 30 days
before commencing voriconazole prophylaxis (OR: 8.4, 95% CI: 2.1-
33.4, p = 0.003) were at higher risk for Aspergillus colonisation at 12-
month end-point. Preliminary analyses suggest that acute rejection
(OR: 4.9, 95% CI: 1.2-19.4, p = 0.026) and chronic rejection (OR: 6.5,
95% CI: 1.3-31.5, p = 0.022) within 30 days prior to voriconazole
prophylaxis were significantly associated with 12-month mortality. LTx
patients older than 55 years old were 5.9 times more likely to have
hepatotoxicity after initiation of prophylaxis (95% CI: 1.1-30.6;
p = 0.036).

Abstract Number: P856

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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