Efficacy of different durations of antifungal prophylaxis with nebulized amphotericin B after lung transplantation: a retrospective cohort study

Background: Nebulized amphotericin B (NAB) is recommended for preventing invasive fungal diseases (IFDs) after lung transplantation. However, the optimal duration of NAB treatment is still unknown. This study aimed to compare the effectiveness of three different durations of antifungal prophylaxis with NAB after lung transplantation: a prolonged course beyond post-transplant 3 months, a medium course of 2 weeks to 3 months, and a short course of less than 2 weeks.Methods: This a single-center retrospective cohort study analyzed 333 patients who underwent lung or heart-lung transplantation between January 2015 and November 2021.Results: A prolonged course of NAB treatment was associated with a significantly lower incidence of IFDs (12.6%) at 1 year post-transplant compared with a short (50.9%) or a medium course (28.0%) (P<0.001). There was no significant difference in the rates of adverse effects among the three durations of NAB treatment (P>0.05). A prolonged course of NAB treatment was associated with a significantly higher 1-year survival rate (94.7%) compared with a short (36.8%) or a medium course (72.0%) (P<0.001).Conclusions: A prolonged course of NAB treatment provided better protection against IFDs than a short or medium course after lung transplantation. Prolonged use of NAB did not significantly increase the incidence of adverse effects.