Trinh Sonya A, Echenique Ignacio A, Penugonda Sudhir, Angarone Michael P
Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Infectious Disease, Cleveland Clinic Florida, Weston, Florida.
Transpl Infect Dis. 2018 Oct;20(5):e12963. doi: 10.1111/tid.12963. Epub 2018 Jul 20.
Although the research is limited, treatment guidelines recommend lifelong suppressive azole therapy for disseminated endemic fungal infection (EFI) after solid organ transplantation (SOT). Suppressive azole therapy may prevent EFI recurrence at the risk of hepatotoxicity and drug interactions. We present real-world safety and effectiveness data of chronic suppressive azole therapy for EFI in SOT recipients over a 10-year period at a single comprehensive transplant center.
A retrospective analysis was conducted of SOT recipients diagnosed with EFI from January 1, 2005, to May 1, 2015. Chronic suppressive azole therapy was defined as treatment for more than 12 months after diagnosis. Effectiveness of suppression was defined as preventing EFI reactivation. Safety endpoints included adverse reactions and drug interactions.
Over a 10-year period, 28 SOT recipients were diagnosed with EFI: 16 histoplasmosis, 9 blastomycosis, and 3 coccidioidomycosis. Eighteen (64%) patients were treated with chronic suppressive azole therapy for a median length of 36 months (range 15-90). One patient had an adverse drug interaction requiring azole discontinuation. There were no episodes of azole-related hepatotoxicity, toxicity from antirejection medication, or EFI reactivation.
Chronic suppressive azole therapy was safe and effective in preventing reactivation of EFI in SOT recipients.
尽管研究有限，但治疗指南推荐对实体器官移植（SOT）后发生播散性地方性真菌感染（EFI）的患者进行终身唑类药物抑制治疗。唑类药物抑制治疗可能会预防EFI复发，但存在肝毒性和药物相互作用的风险。我们呈现了在一家综合性移植中心10年间SOT受者慢性唑类药物抑制治疗EFI的真实世界安全性和有效性数据。
对2005年1月1日至2015年5月1日期间诊断为EFI的SOT受者进行回顾性分析。慢性唑类药物抑制治疗定义为诊断后治疗超过12个月。抑制的有效性定义为预防EFI再激活。安全终点包括不良反应和药物相互作用。
在10年期间，28例SOT受者被诊断为EFI：16例组织胞浆菌病，9例芽生菌病，3例球孢子菌病。18例（64%）患者接受了慢性唑类药物抑制治疗，中位疗程为36个月（范围15 - 90个月）。1例患者发生药物相互作用不良事件，需要停用唑类药物。未发生与唑类药物相关的肝毒性、抗排斥药物毒性或EFI再激活事件。
慢性唑类药物抑制治疗在预防SOT受者EFI再激活方面是安全有效的。
