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Outcomes of antifungal prophylaxis in high-risk liver transplant recipients

S Hadley1, C Huckabee, P G Pappas

  • 1Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA. susan.hadley@bassett.org

Transplant Infectious Disease : an Official Journal of the Transplantation Society
|January 16, 2009
PubMed

Insights

Antifungal prophylaxis effectively reduced invasive fungal infections (IFI) in high-risk liver transplant recipients (LTRs). The 14-day treatment was well-tolerated, showing lower IFI rates than in untreated LTRs.

Area of Science:

  • Transplantation Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Antifungal prophylaxis is standard for high-risk liver transplant recipients (LTRs).
  • Optimal duration and drug choice for antifungal prophylaxis remain undefined.
  • Invasive fungal infections (IFI) pose a significant risk to LTRs.

Purpose of the Study:

  • To evaluate the efficacy of a 14-day antifungal prophylaxis regimen.
  • To compare liposomal amphotericin B and fluconazole for IFI prevention in LTRs.
  • To assess the safety and tolerability of antifungal prophylaxis in high-risk LTRs.

Main Methods:

  • Randomized trial comparing liposomal amphotericin B and fluconazole.
  • 14-day antifungal prophylaxis for high-risk LTRs meeting ≥2 risk criteria.
  • Follow-up for 100 days post-transplantation to monitor for IFI.

Main Results:

  • 71 high-risk LTRs were enrolled; 10 developed proven or probable IFI (Candida, Cryptococcus).
  • IFI rates were comparable between the liposomal amphotericin B and fluconazole arms.
  • Prophylaxis was well-tolerated, with no deaths attributed to study drug or IFI.

Conclusions:

  • 14-day antifungal prophylaxis is well-tolerated in high-risk LTRs.
  • This regimen demonstrated lower IFI rates compared to historical untreated LTRs.
  • Further research is needed to define optimal prophylaxis strategies.

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