Antifungal Prophylaxis During the Early Postoperative Period of Lung Transplantation

Introduction: Fungal infections occur frequently in lung transplant patients, with the highest risk being in the early postoperative period (the initial hospitalization after lung transplantation). Aspergillus is responsible for more than half of all fungal infections, and Aspergillus has even been considered a contraindication for lung transplantation because of its difficult therapy and frequently fatal outcome. The aim of this article is to evaluate the success of an antifungal prophylaxis protocol to prevent fungal infection in the immediate postoperative period in lung transplant recipients. Material and methods: From March 1994 to March 1997, we performed 52 lung transplants in 31 men and 21 women who received antifungal prophylaxis with fluconazole, 400 mg/d, and aerosolized amphotericin B, 0.6 mg/kg/d, during the postoperative period. Results: The mean (6 SD) postoperative period duration was 49 6 27.5 days. No fungal infections were observed during this period, and all patients provided negative cultures. We also found no toxicity related to antifungal drugs. The dose of cyclosporine was easily adjusted in every recipient according to blood levels so that effective immunosuppression was not compromised. Discussion: In our study, the removal of the lungs and antifungal prophylaxis with fluconazole and aerosolized amphotericin B prevented fungal infection in the postoperative period in all 52 lung transplant recipients. (CHEST 1999; 115:1301‐1304) I nfectious complications are frequent in lung transplant patients. Approximately 40% of all deaths occurring after transplantion are caused by infections; 60 to 80% of these infections are respiratory, and half of them are opportunistic.1 Although bacterial infection occurs more frequently (65%), viral and fungal infections are more lethal. The peak incidence of fungal infection occurs in the period from 10 days to 2 months after transplantion.2‐ 4 Aspergillus is responsible for more than half of the fungal infections in lung transplant patients. These patients are more susceptible to Aspergillus because of heavy immunosuppression and the use of broad-spectrum antibiotics. Abnormal local defense mechanisms in the airways of lung transplant recipients also play a role in this high prevalence.3