Impact of Targeted Posaconazole Prophylaxis in Heart Transplant Recipients During an Outbreak of Early Invasive Aspergillosis

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-06-13 DOI:10.1111/ctr.70210

Malo Penven, Céline Goeminne, Camille Ternynck, Severine Loridant, Agnès Perrin, Benjamin Valentin, Karine Faure, Sarah Stabler, Emmanuel Faure, Fanny Vuotto

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引用次数: 0

Abstract

Background

There are no established recommendations for systematic or targeted antifungal prophylaxis in heart transplant recipients (HTRs), resulting in heterogeneous practices. An outbreak of post-surgical invasive aspergillosis (IA) among HTR, which coincided with construction activities near our heart transplant unit, prompted the initiation of primary posaconazole (POS) prophylaxis in patients at highest risk.

Methods

This single-center retrospective descriptive study was conducted from March 2020 to May 2022 and describes the use of POS primary prophylaxis in high-risk HTR. The following risk factors were considered as indications for initiating prophylaxis: re-operation, post-transplantation hemodialysis, post-surgical extracorporeal membrane oxygenation (ECMO), re-transplantation, prolonged post-transplant mechanical ventilation (i.e., >72 h), cytomegalovirus (CMV) infection within the first month post-transplant, and a positive pre-transplant Aspergillus serology. The duration of prophylaxis was individualized, with treatment initiating in response to the risk factor and continuing for a median of 28 days after its resolution.

Results

POS prophylaxis was administered in 12 of 33 HTR (36.4%). The most common risk factors encountered were prolonged mechanical ventilation (>72 h, 91.6%) and CMV infection (58.3%). Most patients (91.6%) had at least two risk factors for IA, and more than half (58.3%) had three or more. Notably, no cases of IA were observed during the study period. Some patients experienced liver function abnormalities and drug–drug interactions.

Conclusion

Targeted POS prophylaxis may be an option for high-risk HTR during an outbreak. Close monitoring of liver function, POS levels, and tacrolimus concentrations is recommended.

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泊沙康唑预防对早期侵袭性曲霉病爆发期间心脏移植受者的影响

背景：对于心脏移植受者（HTRs）系统的或有针对性的抗真菌预防，目前还没有明确的建议，这导致了实践的异质性。HTR手术后侵袭性曲霉病（IA）的爆发，恰逢我们心脏移植单位附近的建设活动，促使高危患者开始泊沙康唑（POS）初级预防。方法该单中心回顾性描述性研究于2020年3月至2022年5月进行，描述了高危HTR中POS初级预防的使用情况。以下危险因素被认为是开始预防的指征：再次手术、移植后血液透析、手术后体外膜氧合（ECMO）、再次移植、移植后机械通气时间延长（即72小时）、移植后1个月内巨细胞病毒（CMV）感染、移植前曲霉血清学阳性。预防的持续时间是个体化的，根据危险因素开始治疗，并在危险因素消退后持续治疗中位数为28天。结果33例HTR患者中有12例（36.4%）采用POS预防。最常见的危险因素是机械通气时间延长（72小时，91.6%）和巨细胞病毒感染（58.3%）。大多数患者（91.6%）至少有两种IA危险因素，超过一半（58.3%）有三种或三种以上。值得注意的是，在研究期间没有观察到IA病例。一些患者出现肝功能异常和药物相互作用。结论有针对性的POS预防可能是疫情期间高危HTR的一种选择。建议密切监测肝功能、POS水平和他克莫司浓度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.