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Safety and Efficacy of Chronic Suppressive Azole Therapy for Endemic Fungal Infections in Solid Organ Transplant Recipients.

Research paper by Sonya A SA Trinh, Ignacio A IA Echenique, Sudhir S Penugonda, Michael P MP Angarone

Indexed on: 06 Jul '18Published on: 06 Jul '18Published in: Transplant Infectious Disease



Abstract

Although the research is limited, treatment guidelines recommend lifelong suppressive azole therapy for disseminated endemic fungal infection (EFI) after solid organ transplantation (SOT). Suppressive azole therapy may prevent EFI recurrence at the risk of hepatotoxicity and drug interactions. We present real-world safety and effectiveness data of chronic suppressive azole therapy for EFI in SOT recipients over a 10-year period at a single comprehensive transplant center. A retrospective analysis was conducted of SOT recipients diagnosed with EFI from 1 January 2005 to 1 May 2015. Chronic suppressive azole therapy was defined as treatment for more than 12 months after diagnosis. Effectiveness of suppression was defined as preventing EFI reactivation. Safety endpoints included adverse reactions and drug interactions. Over a ten-year period, 28 SOT recipients were diagnosed with EFI: 16 histoplasmosis, 9 blastomycosis, and 3 coccidioidomycosis. Eighteen (64%) patients were treated with chronic suppressive azole therapy for a median length of 36 months (range 15-90). One patient had an adverse drug interaction requiring azole discontinuation. There were no episodes of azole-related hepatotoxicity, toxicity from antirejection medication, or EFI reactivation. Chronic suppressive azole therapy was safe and effective in preventing reactivation of EFI in SOT recipients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.