Preemptive treatment with voriconazole in lung transplant recipients

Chin Fen Neoh, Gregory I Snell, Bronwyn Levvey, Anastase Thomas Christos Kotsimbos, Orla Morrissey, Monica Slavin, Kay Stewart, David Chee Ming Kong

Research output: Contribution to journalArticleResearchpeer-review

20 Citations (Scopus)

Abstract

Background: Invasive fungal infection (IFI) is associated with high mortality in lung transplant (LTx) recipients. Data for voriconazole use in preemptive treatment remain scant. Method: A single-center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post-LTx colonization. Results: We reviewed 62 adult LTx patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. Aspergillus fumigatus (75.8 ) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LTx patient (1.6 ) had IFI, 47 (75.8 ) cleared their colonizing isolate, 3 (4.8 ) had persistent colonization, 7 (11.3 ) had recurrent colonization, 1 (1.6 ) had new colonization, 2 (3.2 ) had aspergilloma, and 1 (1.6 ) was clinically unstable with no culture results. Sixteen (25.8 ) had died by 12 months. Ten (16.1 ) had likely drug-related hepatotoxicity. LTx patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months (P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12-month mortality (P = 0.007). Conclusions: Voriconazole preemptive treatment resulted in low incidence of IFI and IFI-related mortality.
Original languageEnglish
Pages (from-to)344 - 353
Number of pages10
JournalTransplant Infectious Disease
Volume15
Issue number4
DOIs
Publication statusPublished - 2013

Cite this

@article{071c24abbc9e4db6b5fa94b2bdc74317,
title = "Preemptive treatment with voriconazole in lung transplant recipients",
abstract = "Background: Invasive fungal infection (IFI) is associated with high mortality in lung transplant (LTx) recipients. Data for voriconazole use in preemptive treatment remain scant. Method: A single-center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post-LTx colonization. Results: We reviewed 62 adult LTx patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. Aspergillus fumigatus (75.8 ) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LTx patient (1.6 ) had IFI, 47 (75.8 ) cleared their colonizing isolate, 3 (4.8 ) had persistent colonization, 7 (11.3 ) had recurrent colonization, 1 (1.6 ) had new colonization, 2 (3.2 ) had aspergilloma, and 1 (1.6 ) was clinically unstable with no culture results. Sixteen (25.8 ) had died by 12 months. Ten (16.1 ) had likely drug-related hepatotoxicity. LTx patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months (P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12-month mortality (P = 0.007). Conclusions: Voriconazole preemptive treatment resulted in low incidence of IFI and IFI-related mortality.",
author = "Neoh, {Chin Fen} and Snell, {Gregory I} and Bronwyn Levvey and Kotsimbos, {Anastase Thomas Christos} and Orla Morrissey and Monica Slavin and Kay Stewart and Kong, {David Chee Ming}",
year = "2013",
doi = "10.1111/tid.12071",
language = "English",
volume = "15",
pages = "344 -- 353",
journal = "Transplant Infectious Disease",
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}

Preemptive treatment with voriconazole in lung transplant recipients. / Neoh, Chin Fen; Snell, Gregory I; Levvey, Bronwyn; Kotsimbos, Anastase Thomas Christos; Morrissey, Orla; Slavin, Monica; Stewart, Kay; Kong, David Chee Ming.

In: Transplant Infectious Disease, Vol. 15, No. 4, 2013, p. 344 - 353.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Preemptive treatment with voriconazole in lung transplant recipients

AU - Neoh, Chin Fen

AU - Snell, Gregory I

AU - Levvey, Bronwyn

AU - Kotsimbos, Anastase Thomas Christos

AU - Morrissey, Orla

AU - Slavin, Monica

AU - Stewart, Kay

AU - Kong, David Chee Ming

PY - 2013

Y1 - 2013

N2 - Background: Invasive fungal infection (IFI) is associated with high mortality in lung transplant (LTx) recipients. Data for voriconazole use in preemptive treatment remain scant. Method: A single-center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post-LTx colonization. Results: We reviewed 62 adult LTx patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. Aspergillus fumigatus (75.8 ) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LTx patient (1.6 ) had IFI, 47 (75.8 ) cleared their colonizing isolate, 3 (4.8 ) had persistent colonization, 7 (11.3 ) had recurrent colonization, 1 (1.6 ) had new colonization, 2 (3.2 ) had aspergilloma, and 1 (1.6 ) was clinically unstable with no culture results. Sixteen (25.8 ) had died by 12 months. Ten (16.1 ) had likely drug-related hepatotoxicity. LTx patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months (P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12-month mortality (P = 0.007). Conclusions: Voriconazole preemptive treatment resulted in low incidence of IFI and IFI-related mortality.

AB - Background: Invasive fungal infection (IFI) is associated with high mortality in lung transplant (LTx) recipients. Data for voriconazole use in preemptive treatment remain scant. Method: A single-center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post-LTx colonization. Results: We reviewed 62 adult LTx patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. Aspergillus fumigatus (75.8 ) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LTx patient (1.6 ) had IFI, 47 (75.8 ) cleared their colonizing isolate, 3 (4.8 ) had persistent colonization, 7 (11.3 ) had recurrent colonization, 1 (1.6 ) had new colonization, 2 (3.2 ) had aspergilloma, and 1 (1.6 ) was clinically unstable with no culture results. Sixteen (25.8 ) had died by 12 months. Ten (16.1 ) had likely drug-related hepatotoxicity. LTx patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months (P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12-month mortality (P = 0.007). Conclusions: Voriconazole preemptive treatment resulted in low incidence of IFI and IFI-related mortality.

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U2 - 10.1111/tid.12071

DO - 10.1111/tid.12071

M3 - Article

VL - 15

SP - 344

EP - 353

JO - Transplant Infectious Disease

JF - Transplant Infectious Disease

SN - 1398-2273

IS - 4

ER -