Department of Respiratory and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Department of Organ Transplant, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Med Mycol. 2022 Sep 2;60(9). doi: 10.1093/mmy/myac041.
Invasive fungal diseases (IFDs) are one of the leading causes of death in lung transplant recipients. This study aimed to compare the antifungal prophylactic effectiveness, intrapulmonary and plasma levels of voriconazole with posaconazole in lung transplant recipients. This retrospective cohort study analyzed adult recipients who underwent lung transplantation between June 2017 and December 2020. Voriconazole oral tablets or posaconazole oral suspension was used for prophylaxis against posttransplant IFD. Drug concentrations in bronchoalveolar lavage fluid (BALF) and plasma were measured by using liquid chromatography-mass spectrometry. The 182 recipients included 142 in the voriconazole group and 40 in the posaconazole group. The trough plasma levels were comparable between voriconazole and posaconazole (1.65 ± 0.09 vs. 1.69 ± 0.03 μg/ml, P = 0.55). However, the BALF levels were significantly higher for posaconazole than voriconazole (17.47 ± 11.51 vs. 0.56 ± 0.49 μg/ml, P < 0.001). There was no significant difference in the total incidence of breakthrough IFDs between the voriconazole and posaconazole groups (10.6% vs. 7.5%, P = 0.77). The intrapulmonary concentrations of posaconazole were significantly higher than voriconazole. The two agents had comparable antifungal prophylactic effectiveness.
侵袭性真菌病（IFD）是肺移植受者死亡的主要原因之一。本研究旨在比较肺移植受者中伏立康唑与泊沙康唑的抗真菌预防效果、肺内和血浆水平。这项回顾性队列研究分析了 2017 年 6 月至 2020 年 12 月期间接受肺移植的成年受者。伏立康唑口服片剂或泊沙康唑口服混悬液用于预防移植后 IFD。通过液相色谱-质谱法测量支气管肺泡灌洗液（BALF）和血浆中的药物浓度。182 名受者包括 142 名伏立康唑组和 40 名泊沙康唑组。伏立康唑和泊沙康唑的谷血浆水平相当（1.65±0.09 与 1.69±0.03μg/ml，P=0.55）。然而，泊沙康唑的 BALF 水平明显高于伏立康唑（17.47±11.51 与 0.56±0.49μg/ml，P<0.001）。伏立康唑组和泊沙康唑组总的突破性 IFD 发生率无显著差异（10.6%比 7.5%，P=0.77）。泊沙康唑的肺内浓度明显高于伏立康唑。两种药物具有相当的抗真菌预防效果。
