Invasive fungal infections remain a significant concern following heart transplantation, necessitating effective antifungal prophylaxis. This single-center, retrospective cohort study, published in the Open Forum Infectious Disease, evaluated the comparative efficacy and safety of itraconazole and posaconazole in heart transplant (HT) recipients. 

The analysis included patients receiving antifungal prophylaxis between January 2015 and May 2022. A total of 134 patients received itraconazole, while 98 patients received posaconazole, with a standard prophylaxis duration of 3 months in both groups. The primary efficacy outcome was the incidence of fungal infection, and the primary safety outcome was hepatic dysfunction after therapy initiation.

Patients in the itraconazole group were more likely to receive induction immunosuppression (P<0.001) and undergo combined heart-kidney transplantation, while other baseline characteristics were comparable between groups. 

The incidence of fungal infection was higher in the itraconazole cohort compared with the posaconazole cohort (7.4% vs 0%; P=0.0065). Additionally, patients receiving itraconazole were more likely to require a change to an alternative antifungal therapy (20.9% vs 10.2%; P=0.03). Rates of adverse events, including hepatic dysfunction, were similar across both treatment groups.

These findings indicate differences in antifungal prophylaxis outcomes between the two agents in HT recipients. Further evaluation may help clarify optimal prophylaxis strategies in this population.