What is your preferred agent for fungal prophylaxis in a patient post lung transplant with abnormal LFTs?

Isavuconazonium tends to cause less elevations in LFTs.

Answer: Isavuconazole

Rationale:

Azole hepatotoxicity in my experience is ranked as following:

Voriconazole>Posaconazole>isavuconazole or itraconazole or fluconazole.

Therefore, my choice for lung transplant fungal prohylaxis is either itraconazole or isavuconazole if there is not pre-transplant colonization of the native lung with concerning fungal pathogens. However there are several caveats: 1) itraconazole capsule absorption is poor when given with PPIs that are typically used post lung tran...