TY - JOUR
T1 - Antifungal prophylaxis in lung transplant recipients
T2 - A systematic review and meta-analysis
AU - Pennington, Kelly M.
AU - Baqir, Misbah
AU - Erwin, Patricia J.
AU - Razonable, Raymund R.
AU - Murad, Mohammad Hassan
AU - Kennedy, Cassie C.
N1 - Funding Information:
KMP is supported by The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. CCK is supported by The National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K23HL128859. The manuscript contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: No consensus exists regarding optimal strategy for antifungal prophylaxis following lung transplant. Objective: To review data regarding antifungal prophylaxis on the development of fungal infections. Study selection/Appraisal: We searched MEDLINE, Embase, and Scopus for eligible articles through December 10, 2019. Observational or controlled trials published after January 1, 2001, that pertained to the prevention of fungal infections in adult lung recipients were reviewed independently by two reviewers for inclusion. Methods: Of 1702 articles screened, 24 were included. Data were pooled using random effects model to evaluate for the primary outcome of fungal infection. Studies were stratified by prophylactic strategy, medication, and duration (short term < 6 months and long term ≥ 6 months). Results: We found no difference in the odds of fungal infection with universal prophylaxis (49/101) compared to no prophylaxis (36/93) (OR 0.76, CI: 0.03-17.98; I2 = 93%) and preemptive therapy (25/195) compared to universal prophylaxis (35/222) (OR 0.91, CI: 0.06-13.80; I2 = 93%). The cumulative incidence of fungal infections within 12 months was not different with nebulized amphotericin (0.08, CI: 0.04-0.13; I2 = 87%) compared to systemic triazoles (0.07, CI: 0.03-0.11; I2 = 21%) (P =.65). Likewise, duration of prophylaxis did not impact the incidence of fungal infections (short term: 0.11, CI: 0.05-0.17; I2 = 89%; long term: 0.06, CI: 0.03-0.08; I2 = 51%; P =.39). Conclusions: We have insufficient evidence to support or exclude a benefit of antifungal prophylaxis.
AB - Background: No consensus exists regarding optimal strategy for antifungal prophylaxis following lung transplant. Objective: To review data regarding antifungal prophylaxis on the development of fungal infections. Study selection/Appraisal: We searched MEDLINE, Embase, and Scopus for eligible articles through December 10, 2019. Observational or controlled trials published after January 1, 2001, that pertained to the prevention of fungal infections in adult lung recipients were reviewed independently by two reviewers for inclusion. Methods: Of 1702 articles screened, 24 were included. Data were pooled using random effects model to evaluate for the primary outcome of fungal infection. Studies were stratified by prophylactic strategy, medication, and duration (short term < 6 months and long term ≥ 6 months). Results: We found no difference in the odds of fungal infection with universal prophylaxis (49/101) compared to no prophylaxis (36/93) (OR 0.76, CI: 0.03-17.98; I2 = 93%) and preemptive therapy (25/195) compared to universal prophylaxis (35/222) (OR 0.91, CI: 0.06-13.80; I2 = 93%). The cumulative incidence of fungal infections within 12 months was not different with nebulized amphotericin (0.08, CI: 0.04-0.13; I2 = 87%) compared to systemic triazoles (0.07, CI: 0.03-0.11; I2 = 21%) (P =.65). Likewise, duration of prophylaxis did not impact the incidence of fungal infections (short term: 0.11, CI: 0.05-0.17; I2 = 89%; long term: 0.06, CI: 0.03-0.08; I2 = 51%; P =.39). Conclusions: We have insufficient evidence to support or exclude a benefit of antifungal prophylaxis.
KW - aspergillus
KW - fungal infection
KW - lung transplant
KW - prophylaxis
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U2 - 10.1111/tid.13333
DO - 10.1111/tid.13333
M3 - Article
C2 - 32449237
AN - SCOPUS:85089118089
SN - 1398-2273
VL - 22
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
IS - 4
M1 - e13333
ER -