Isavuconazole (ISA) is an alternative treatment for Aspergillus spp. and other
fungal infections, but evidence regarding its use in solid organ transplant recipients (SOTR) is scarce. All SOTR who received ISA for treatment of a
fungal infection (FI) at our center from December 2017 to January 2021 were included. The duration of the treatment depended on the type of
infection. All patients were followed up to 3 months
after treatment. Fifty-three SOTR were included, and the majority (44, 83%) were lung transplant recipients. The most frequently treated FI was tracheobronchitis (25, 46.3%). Aspergillus spp. (43, 81.1%); specially A. flavus (16, 37.2%) and A. fumigatus (12, 27.9%), was the most frequent etiology. Other filamentous fungi including one
mucormycosis, and four yeast
infections were treated. The median
duration of treatment was 81 days (IQR 15-197). Mild
gamma-glutamyltransferase elevation was the most frequent adverse event (34%). ISA was prematurely discontinued in six patients (11.3%) due to mild hepatotoxicity (2),
fatigue (2), gastrointestinal intolerance (1) and
myopathy (1). The mean
tacrolimus dose decrease was 30% after starting ISA. Seven patients received ISA with
mTOR inhibitors with good tolerability. Two patients developed breakthrough FI (3.8%). Among patients who completed the treatment, 27 (50.9%) showed clinical cure and 15 (34.1%) presented fungal persistence. Three patients (6%) died while on ISA due to FI. ISA was well tolerated and appeared to be an effective treatment for FI in SOTR. IMPORTANCE We describe 53 solid organ transplant recipients treated with
isavuconazole for
fungal infections. Because its use in clinical practice, there is scarce data of its use in solid organ transplant recipients, where interactions with
calcineurin inhibitors and mTOR and
adverse drug events have limited the use of other
triazoles. To the best of our knowledge, this is the first article describing the safety regarding adverse events and drug interactions of
isavuconazole for the treatment of
fungal infections in a cohort of solid organ transplant recipients. Also, although this is a noncomparative study, we report some real world effectivity data of these patients, including treatment of non-Aspergillus
fungal infections.