Breakthrough mold infections during long-term Nebulized Liposomal Amphotericin B prophylaxis in lung transplant recipients: a single-center cohort (NEBULA study)
Monforte Pallares, Arnau (Universitat Autònoma de Barcelona)
Los-Arcos, Ibai (Vall d'Hebron Institut de Recerca (VHIR))
Martin-Gomez, M. Teresa (Vall d'Hebron Institut de Recerca (VHIR))
Berastegui García, Cristina (Vall d'Hebron Institut de Recerca (VHIR))
Marquez-Algaba, Ester (Vall d'Hebron Institut de Recerca (VHIR))
Sacanell, Judith (Vall d'Hebron Institut de Recerca (VHIR))
Rosado Rodríguez, Joel (Vall d'Hebron Institut de Recerca (VHIR))
Falcó Roget, Anna (Vall d'Hebron Institut de Recerca (VHIR))
Escudero, Gonzalo (Vall d'Hebron Institut de Recerca (VHIR))
Casanovas, Jose (Vall d'Hebron Institut de Recerca (VHIR))
Kirkegaard, Cristina (Vall d'Hebron Institut de Recerca (VHIR))
Sáez-Giménez, Berta (Vall d'Hebron Institut de Recerca (VHIR))
Monforte, Víctor (Vall d'Hebron Institut de Recerca (VHIR))
Gavaldà, Joan (Vall d'Hebron Institut de Recerca (VHIR))
Len, Oscar (Universitat Autònoma de Barcelona. Departament de medicina)

Date:	2026
Abstract:	Introduction: Aspergillus spp. and other mold infections are the most common fungal infections in lung transplant recipients (LTR). There is no established antifungal preventive strategy for LTR; however, lifelong nebulized liposomal amphotericin B (n-LAB) prophylaxis has been used in our center. This study evaluated breakthrough mold infections (b-MI) and the tolerability of n-LAB prophylaxis in a LTR cohort. Methods: This observational retrospective study included all consecutive adult LTR who received n-LAB prophylaxis between August 2013 and March 2023. Participants were followed up for at least one year post-transplant unless they died earlier. Only proven and probable mold infections during n-LAB exposure were included in the study. Results: Among 802 LTR (median age: 57. 8 years; 41. 9% female), 821 transplants were performed. The incidence of b-MI within the first year post-transplantation was 8. 7%. Over a median follow-up of 2. 56 years (IQR 1. 01-5. 25), 94 LTR (11. 7%) developed b-MI, comprising 111 episodes of infection. Independent risk factors for b-MI included bronchial stenosis, bronchial stent placement, and single lung transplant. Prophylaxis with n-LAB was well tolerated, with discontinuation owing to adverse events occurring in only 18 participants (2. 2%). Mold colonization and b-MI were both associated with an increased risk of death, aHR 5. 38 (95% CI: 3. 24-8. 94) and 14. 07 (95% CI: 8. 50-23. 28), respectively. No difference in mortality was observed between the amphotericin B-non-susceptible isolates. Conclusion: Lifelong n-LAB prophylaxis was associated with a low incidence of mold infection during prolonged follow-up and maintained excellent tolerability. The emergence of amphotericin B-non-susceptible molds was not associated with increased mortality.
Rights:	Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets.
Language:	Anglès
Document:	Article ; recerca ; Versió acceptada per publicar
Subject:	Lung transplantation ; Antifungal prophylaxis ; Aspergillus ; Inhaled
Published in:	Transplantation, 2026 , ISSN 1534-6080

Available from: 2099-01-01 Postprint 43 p, 1.6 MB

The record appears in these collections:
Articles > Research articles
Articles > Published articles