Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis—A Nationwide Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Invasive Aspergillosis
Review Process for Classification of Invasive Aspergillosis
2.2. Prophylaxis and Immunosuppressive Protocols
2.3. Routine Sampling and Microbiological Analyses
2.4. Statistics
3. Results
3.1. Baseline Characteristics
3.2. Invasive Aspergillosis
3.3. Associations between Prophylaxis and Invasive Aspergillosis
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Targeted Antifungal Prophylaxis Guideline for High-Risk Patients
- Cystic fibrosis;
- Sarcoidosis;
- Hypogammaglobulinemia;
- Impaired ciliary function;
- Cytomegalovirus infection;
- High-dose corticosteroids;
- Antilymphocyte treatment;
- Older age;
- Renal insufficiency;
- Patients with previous mold infections;
- All patients with retransplantation.
Appendix B. Antimicrobial Prophylaxis Protocols
References
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Universal Prophylaxis Period, 2010–2016 (N = 193) | Targeted Prophylaxis Period, 2016–2019 (N = 102) | P-Value | |
---|---|---|---|
Male, n (%) | 106 (55) | 46 (45) | 0.11 |
Age, years, median (IQR) | 52 (42, 57) | 55 (45, 58) | 0.04 |
Underlying disease, n (%) | |||
Emphysema | 84 (44) | 52 (51) | 0.27 |
Primary pulmonary hypertension | 5 (3) | 5 (5) | 0.32 |
Pulmonary fibrosis | 50 (26) | 33 (32) | 0.28 |
Cystic fibrosis * | 36 (19) | 8 (8) | 0.02 |
Retransplantation * | 6 (3) | 1 (1) | 0.43 |
Sarcoidosis * | 12 (6) | 3 (3) | 0.28 |
Single lung transplant, n (%) | 25 (13) | 5 (5) | 0.04 |
Aspergillus prior to transplantation, n (%) | 18 (9) | 6 (6) | 0.49 |
Initiated antifungal prophylaxis, n (%) | 183 (95) | 6 (6) | <0.001 |
Completed ≥ 9/12 weeks of prophylaxis, n (%) | 69/183 (38) | 4/6 (67) | 0.20 |
Incidence Rate of IA per 100 Person Years of Follow-Up (95% CI) | Model 1 Universal vs. Targeted Period | Model 2 Person-Time on vs. without Prophylaxis | |||
---|---|---|---|---|---|
Universal period | Targeted period | HR (95% CI) | aHR 1 (95% CI) | HR (95% CI) | aHR 2 (95% CI) |
16.6 (11.4–24.2) | 17.5 (10.7–29.1) | 0.92 (0.49–1.73) | 0.94 (0.49–1.82) | 0.39 (0.15–1.01) | 0.36 (0.12–1.02) |
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Crone, C.G.; Wulff, S.M.; Ledergerber, B.; Helweg-Larsen, J.; Bredahl, P.; Arendrup, M.C.; Perch, M.; Helleberg, M. Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis—A Nationwide Cohort Study. J. Fungi 2023, 9, 1079. https://doi.org/10.3390/jof9111079
Crone CG, Wulff SM, Ledergerber B, Helweg-Larsen J, Bredahl P, Arendrup MC, Perch M, Helleberg M. Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis—A Nationwide Cohort Study. Journal of Fungi. 2023; 9(11):1079. https://doi.org/10.3390/jof9111079
Chicago/Turabian StyleCrone, Cornelia Geisler, Signe Marie Wulff, Bruno Ledergerber, Jannik Helweg-Larsen, Pia Bredahl, Maiken Cavling Arendrup, Michael Perch, and Marie Helleberg. 2023. "Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis—A Nationwide Cohort Study" Journal of Fungi 9, no. 11: 1079. https://doi.org/10.3390/jof9111079
APA StyleCrone, C. G., Wulff, S. M., Ledergerber, B., Helweg-Larsen, J., Bredahl, P., Arendrup, M. C., Perch, M., & Helleberg, M. (2023). Invasive Aspergillosis among Lung Transplant Recipients during Time Periods with Universal and Targeted Antifungal Prophylaxis—A Nationwide Cohort Study. Journal of Fungi, 9(11), 1079. https://doi.org/10.3390/jof9111079