Cadena J, Levine D J, Angel L F, Maxwell P R, Brady R, Sanchez J F, Michalek J E, Levine S M, Restrepo M I
Division of Infectious Diseases, Department of Medicine, The University of Texas Health Science Center at San Antonio (UTHSCSA), TX, USA.
Am J Transplant. 2009 Sep;9(9):2085-91. doi: 10.1111/j.1600-6143.2009.02734.x. Epub 2009 Jul 23.
Invasive fungal infections (IFI) are common after lung transplantation and there are limited data for the use of antifungal prophylaxis in these patients. Our aim was to compare the safety and describe the effectiveness of universal prophylaxis with two azole regimens in lung transplant recipients. This is a retrospective study in lung transplant recipients from July 2003 to July 2006 who received antifungal prophylaxis with itraconazole or voriconazole plus inhaled amphotericin B to compare the incidence of hepatotoxicity. Secondary outcomes include describing the incidence of IFI, clinical outcomes after IFI and mortality. Sixty-seven consecutive lung transplants received antifungal prophylaxis, 32 itraconazole and 35 voriconazole and inhaled amphotericin B. There were no significant differences between groups in the acute physiology and chronic health evaluation (APACHE) score at the time of transplantation, demographic characteristics, comorbidities and concomitant use of hepatotoxic medications. Hepatotoxicity occurred in 12 patients receiving voriconazole and inhaled amphotericin B and in no patients receiving itraconazole (p < 0.001). There was no significant difference between groups with regard to the percentage of transplants with IFI, but one case of zygomycosis occurred in a transplant treated with voriconazole. Voriconazole prophylaxis after lung transplantation was associated with a higher incidence of hepatotoxicity and similar clinical effectiveness when compared to itraconazole.
侵袭性真菌感染（IFI）在肺移植后很常见，而关于这些患者使用抗真菌预防治疗的数据有限。我们的目的是比较两种唑类方案进行普遍预防治疗在肺移植受者中的安全性，并描述其有效性。这是一项对2003年7月至2006年7月期间接受抗真菌预防治疗的肺移植受者进行的回顾性研究，这些受者接受了伊曲康唑或伏立康唑加吸入性两性霉素B的治疗，以比较肝毒性的发生率。次要结果包括描述IFI的发生率、IFI后的临床结果和死亡率。连续67例肺移植受者接受了抗真菌预防治疗，其中32例接受伊曲康唑治疗，35例接受伏立康唑加吸入性两性霉素B治疗。两组在移植时的急性生理与慢性健康状况评估（APACHE）评分、人口统计学特征、合并症以及同时使用肝毒性药物方面均无显著差异。接受伏立康唑加吸入性两性霉素B治疗的12例患者出现了肝毒性，而接受伊曲康唑治疗的患者未出现肝毒性（p<0.001）。两组在发生IFI的移植比例方面无显著差异，但在接受伏立康唑治疗的一例移植中发生了1例接合菌病。与伊曲康唑相比，肺移植后使用伏立康唑预防治疗的肝毒性发生率更高，但临床有效性相似。
