Antifungal prophylaxis in lung transplant recipients: A systematic review and meta-analysis

Background No consensus exists regarding optimal strategy for antifungal prophylaxis following lung transplant. Objective To review data regarding antifungal prophylaxis on the development of fungal infections. Study selection/Appraisal We searched MEDLINE, Embase, and Scopus for eligible articles through December 10, 2019. Observational or controlled trials published after January 1, 2001, that pertained to the prevention of fungal infections in adult lung recipients were reviewed independently by two reviewers for inclusion. Methods Of 1702 articles screened, 24 were included. Data were pooled using random effects model to evaluate for the primary outcome of fungal infection. Studies were stratified by prophylactic strategy, medication, and duration (short term < 6 months and long term >= 6 months). Results We found no difference in the odds of fungal infection with universal prophylaxis (49/101) compared to no prophylaxis (36/93) (OR 0.76, CI: 0.03-17.98;I-2 = 93%) and preemptive therapy (25/195) compared to universal prophylaxis (35/222) (OR 0.91, CI: 0.06-13.80;I-2 = 93%). The cumulative incidence of fungal infections within 12 months was not different with nebulized amphotericin (0.08, CI: 0.04-0.13;I-2 = 87%) compared to systemic triazoles (0.07, CI: 0.03-0.11;I-2 = 21%) (P = .65). Likewise, duration of prophylaxis did not impact the incidence of fungal infections (short term: 0.11, CI: 0.05-0.17;I-2 = 89%; long term: 0.06, CI: 0.03-0.08;I-2 = 51%;P = .39). Conclusions We have insufficient evidence to support or exclude a benefit of antifungal prophylaxis.