Study finds lung transplant patients not given antifungal preventive drugs have higher risk of death

September 23, 2020

ROCHESTER, Minn. -- Antifungal preventive medications reduce mortality risk by half in the first year following lung transplantation, according to Mayo Clinic research involving 667 patients who received lung transplants from 2005 to 2018.

The retrospective study, published in the Annals of the American Thoracic Society, is the largest ever to evaluate the effectiveness of antifungal preventive drugs in lung transplant recipients who are particularly susceptible to invasive fungal infections. These infections are associated with a nearly threefold increase in mortality for lung transplant recipients.

Mayo Clinic researchers used deidentified administrative claims data from OptumLabs Data Warehouse. The study analyzed data for adult patients who underwent single or double lung transplant, or concurrent heart-lung transplant, in the U.S. between Jan. 1, 2005, and Dec. 31, 2018. Of the 667 patients, 385, or 57.8%, received antifungal treatment and 282, or 42.3%, did not. Sixty-five patients died during the study, and all-cause mortality was significantly lower in those patients who received antifungal medications.

"Use of antifungal preventive medications in lung transplant patients is increasingly common, but no studies have established its efficacy," says Kelly Pennington, M.D., the study's first author. "This is the first study to demonstrate a mortality benefit associated with the use of antifungal prophylaxis in lung transplant patients. We still do not know which lung transplant patients receive the most benefit from these medications, and there are other unanswered questions that will require more research." Dr. Pennington is a Mayo Clinic Scholar in the Division of Pulmonary and Critical Care Medicine.

A 2019 Mayo Clinic study found that 90% of U.S. transplant centers routinely prescribe antifungal preventive medications after lung transplant, but no prospective studies have established the benefits of these medications. "In our retrospective study, the risk of death within the first year posttransplant is about twice as high in patients not receiving antifungal preventive treatment, compared with those receiving treatment," says Dr. Pennington.

Itraconazole and voriconazole were the two most common antifungal preventive medications prescribed in the study. Patients who received antifungal drugs had a lower rate of fungal infections than those who did not, though the difference was not statistically significant.

Protracted use of antifungal drugs can have negative health effects, including cardiomyopathy, skin cancer and liver dysfunction. Also, antifungal medications are expensive and can interact with other medications. Therefore, the health care team must monitor anti-fungal medications closely.

"Given the variation in practice among transplant centers, the potential for medication side effects, medication costs and risk of drug interactions, it was imperative to determine whether antifungal preventive medications are beneficial for lung transplant recipients," says Cassie Kennedy, M.D., senior author. "Our finding of a significant reduction in mortality risk among lung transplant recipients who received antifungal medications is consistent with several prior studies in hematologic malignancies and bone marrow transplant patients." Dr. Kennedy is a physician in Mayo Clinic's Division of Pulmonary and Critical Care Medicine. None of the authors has a conflict of interest to disclose. Dr. Kennedy is supported by HNLB1 grant K23 HL128859 from the National Institutes of Health (NIH). Dr. Pennington is supported by Mayo Clinic's Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Nilay Shah, Ph.D., is supported by grants from the Centers of Medicare & Medicaid Innovation Center, Food and Drug Administration, Agency for Healthcare Research and Quality, NIH's National Heart, Lung and Blood Institute, Medical Devices Innovation Consortium/National Evaluation System for Health Technology, National Science Foundation, and Patient-Centered Outcomes Research Institute.
About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and Mayo Clinic Facts for more information about Mayo.

Mayo Clinic

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to