Preemptive treatment with voriconazole in lung transplant recipients

Abstract Background Invasive fungal infection ( IFI ) is associated with high mortality in lung transplant ( LT x) recipients. Data for voriconazole use in preemptive treatment remain scant. Method A single‐center, retrospective cohort study was conducted to investigate the efficacy and safety of voriconazole preemptive treatment for post‐ LT x colonization. Results We reviewed 62 adult LT x patients, who received their first course of voriconazole prophylaxis (i.e., as preemptive treatment) between July 2003 and June 2010. Outcomes were determined at 6 and 12 months after commencing therapy. Aspergillus fumigatus (75.8%) was the most common colonizing isolate. Median duration of voriconazole prophylaxis was 85 days. At 6 months, 1 LT x patient (1.6%) had IFI , 47 (75.8%) cleared their colonizing isolate, 3 (4.8%) had persistent colonization, 7 (11.3%) had recurrent colonization, 1 (1.6%) had new colonization, 2 (3.2%) had aspergilloma, and 1 (1.6%) was clinically unstable with no culture results. Sixteen (25.8%) had died by 12 months. Ten (16.1%) had likely drug‐related hepatotoxicity. LT x patients with diabetes mellitus within 30 days before commencing prophylaxis were at higher risk of recurrent Aspergillus colonization at 6 months ( P = 0.030). Chronic rejection within 30 days before prophylaxis was associated with 12‐month mortality ( P = 0.007). Conclusions Voriconazole preemptive treatment resulted in low incidence of IFI and IFI ‐related mortality.