Scientific Poster Session I - Original Research

Abstract

Research Question or Hypothesis: What is the risk for coccidioidomycosis among lung transplant recipients transferring care to SJHMC, which is located within a highly endemic region for Coccidioides (Phoenix, AZ)?

Study Design: Retrospective, descriptive cohort study

Methods: Lung transplant recipients transplanted between 2010-2023 before transferring to SJHMC for re-transplant or general post-transplant follow-up were included. The primary outcome was the incidence of proven or probable coccidioidomycosis per 2020 Mycoses Study Group consensus definitions. A secondary outcome was to describe azole antifungal prophylaxis before and after transfer and comment on its potential effectiveness in preventing coccidioidomycosis in this population.

Results: Forty lung transplant recipients transplanted at outside facilities were included, with 62.5% not receiving antifungal prophylaxis upon transfer. In patients receiving prophylaxis, fluconazole represented the most common azole. Of those not on prophylaxis, 96% were initiated on azole therapy at first clinic visit, with 48% prescribed itraconazole capsules. Coccidioides serologic testing was performed in 30% of the cohort. After a median follow-up of 31 months, one proven case of pulmonary coccidioidomycosis (2.5%) occurred during the study period, occurring 4.8 years post-transplant and >2 years post-transfer in a patient with cystic fibrosis who had paused azole prophylaxis for over a month due to gastrointestinal intolerance and access issues.

Conclusion: Initiation of azole prophylaxis at the time of transfer was associated with a low rate of coccidioidomycosis among lung transplant recipients relocating to the highly endemic region.

Presenting Author

Authors