Lung transplant recipients who were given antifungal medications prophylactically to prevent invasive fungal infections had lower rates of mortality, according to the results of a recent study published in Annals of the American Thoracic Society.

Medical records from adult patients undergoing lung transplants were retrospectively reviewed. Rates of all-cause mortality and invasive fungal infections were compared between patients who received or not did not receive antifungal prophylaxis.

Of the 662 lung transplant recipients, 387 received antifungal prophylaxis and 275 did not. The indication for lung transplant was similar between both groups, and the mean follow-up was 283.6 days after transplantation. The most common medications used were voriconazole and itraconazole, and the mean duration of antifungal prophylaxis was 133.0 days.

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When compared between the groups, all-cause mortality was significantly lower in the antifungal prophylaxis group compared to the no prophylaxis group. The event rate per 100 person-years was 8.36 compared with 19.49 for the antifungal prophylaxis group and no prophylaxis group, respectively (hazard ratio [HR], 0.48; 95% CI, 0.26-0.71; P =.001). In particular, all-cause mortality was significantly lower in patients who received mold-active triazole prophylaxis (event rate per 100 person-years, 8.10 vs 19.49; HR, 0.42; 95% CI, 0.25-0.72; P =.002). Additionally, patients receiving antifungal prophylaxis had a lower rate of invasive fungal infections.

The study authors noted that in lung transplant recipients, the use of antifungal prophylaxis was associated with an approximately 50% decrease in all-cause mortality compared to no prophylaxis. They added, “This held true even when evaluating individuals specifically receiving systemic ‘mold-active’ antifungal agents compared to no prophylaxis.”


Pennington KM, Dykhoff HJ, Yao X, et al. The impact of antifungal prophylaxis in lung transplant recipients. Ann Am Thorac Soc. Published September 23, 2020. doi:10.1513/AnnalsATS.202003-267OC