Division of Pulmonary and Critical Care Medicine, Department of Medicine.
Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery.
Ann Am Thorac Soc. 2021 Mar;18(3):468-476. doi: 10.1513/AnnalsATS.202003-267OC.
Many lung transplant centers prescribe antifungal medications after transplantation to prevent invasive fungal infections (IFIs); however, the effectiveness of antifungal prophylaxis at reducing the risk of all-cause mortality or IFI has not been established. We aimed to evaluate the effect of antifungal prophylaxis on all-cause mortality and IFI in lung transplant patients. Using administrative claims data, we identified adult patients who underwent lung transplantation between January 1, 2005, and December 31, 2018. Propensity score analysis using inverse probability treatment-weighting approach was used to balance the differences in baseline characteristics between those receiving antifungal prophylaxis and those not receiving antifungal prophylaxis. Cox proportional hazards regression was used to compare rates of all-cause mortality and IFI in both groups. We identified 662 lung transplant recipients (LTRs) (387 received prophylaxis and 275 did not). All-cause mortality was significantly lower in those receiving antifungal prophylaxis compared with those not receiving antifungal prophylaxis (event rate per 100 person-years, 8.36 vs. 19.49; hazard ratio, 0.43; 95% confidence interval, 0.26-0.71; = 0.003). Patients receiving antifungal prophylaxis had a lower rate of IFI compared with those not receiving prophylaxis (event rate per 100 person-years, 14.94 vs. 22.37; hazard ratio, 0.68; 95% confidence interval, 0.44-1.05; = 0.079), but did not reach statistical significance. In this real-world analysis, antifungal prophylaxis in LTRs was associated with reduced all-cause mortality compared with those not receiving antifungal prophylaxis. Rates of IFI were also lower in those receiving prophylaxis, but this was not statistically significant in our primary analysis.
许多肺移植中心在移植后会开具抗真菌药物来预防侵袭性真菌感染（IFI）；然而，抗真菌预防是否能降低全因死亡率或 IFI 的风险尚未确定。我们旨在评估肺移植患者中抗真菌预防对全因死亡率和 IFI 的影响。使用行政索赔数据，我们确定了 2005 年 1 月 1 日至 2018 年 12 月 31 日期间接受肺移植的成年患者。使用逆概率处理权重方法进行倾向评分分析，以平衡接受抗真菌预防和未接受抗真菌预防的患者之间的基线特征差异。使用 Cox 比例风险回归比较两组的全因死亡率和 IFI 发生率。我们确定了 662 名肺移植受者（LTR）（387 名接受预防治疗，275 名未接受预防治疗）。与未接受抗真菌预防的患者相比，接受抗真菌预防的患者全因死亡率显著降低（每 100 人年的事件发生率，8.36 与 19.49；风险比，0.43；95%置信区间，0.26-0.71； = 0.003）。与未接受预防治疗的患者相比，接受抗真菌预防的患者 IFI 的发生率较低（每 100 人年的事件发生率，14.94 与 22.37；风险比，0.68；95%置信区间，0.44-1.05； = 0.079），但差异无统计学意义。在这项真实世界的分析中，与未接受抗真菌预防的患者相比，LTR 中抗真菌预防与降低全因死亡率相关。接受预防治疗的患者 IFI 的发生率也较低，但在我们的主要分析中，这没有统计学意义。
