Husain S, Paterson D L, Studer S, Pilewski J, Crespo M, Zaldonis D, Shutt K, Pakstis D L, Zeevi A, Johnson B, Kwak E J, McCurry K R
Division of Infectious Diseases, University of Pittsburgh Medical Center, Pennsylvania, USA.
Am J Transplant. 2006 Dec;6(12):3008-16. doi: 10.1111/j.1600-6143.2006.01548.x.
Lung transplant recipients have one of the highest rates of invasive aspergillosis (IA) in solid organ transplantation. We used a single center, nonrandomized, retrospective, sequential study design to evaluate fungal infection rates in lung transplant recipients who were managed with either universal prophylaxis with voriconazole (n = 65) or targeted prophylaxis (n = 30) with itraconazole +/- inhaled amphotericin in patients at high risk (pre- or posttransplant Aspergillus colonization [except Aspergillus niger]). The rate of IA at 1 year was better in lung transplant recipients receiving voriconazole prophylaxis as compared to the cohort managed with targeted prophylaxis (1.5% vs. 23%; p = 0.001). Twenty-nine percent of cases in the targeted prophylaxis group were in patients colonized with A. niger who did not receive itraconazole. A three-fold or higher increase in liver enzymes was noted in 37-60% of patients receiving voriconazole prophylaxis as compared to 15-41% of patients in the targeted prophylaxis cohort. Fourteen percent in the voriconazole group as compared to 8% in the targeted prophylaxis group had to discontinue antifungal medications due to side effects. Voriconazole prophylaxis can be used in preventing IA in lung transplant recipients. Regular monitoring of liver enzymes and serum concentrations of calcineurin inhibitors are required to avoid hepatotoxicity and nephrotoxicity.
肺移植受者是实体器官移植中侵袭性曲霉病（IA）发生率最高的群体之一。我们采用单中心、非随机、回顾性、序贯研究设计，评估接受伏立康唑全身预防（n = 65）或接受伊曲康唑 +/- 吸入性两性霉素进行靶向预防（n = 30）的高危患者（移植前或移植后曲霉定植[除黑曲霉外]）的肺移植受者的真菌感染率。与接受靶向预防的队列相比，接受伏立康唑预防的肺移植受者1年时的IA发生率更低（1.5% 对 23%；p = 0.001）。靶向预防组中29% 的病例发生在未接受伊曲康唑治疗的黑曲霉定植患者中。与靶向预防队列中15 - 41% 的患者相比，接受伏立康唑预防的患者中有37 - 60% 的患者肝酶升高了三倍或更高。伏立康唑组中有14% 的患者因副作用不得不停用抗真菌药物，而靶向预防组中这一比例为8%。伏立康唑预防可用于预防肺移植受者的IA。需要定期监测肝酶和钙调神经磷酸酶抑制剂的血清浓度，以避免肝毒性和肾毒性。
