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Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Targeted caspofungin prophylaxis for invasive aspergillosis in high-risk liver transplant recipients, a single-center
Arpita Chakravarti1, Guillaume Butler-Laporte2, Francois Martin Carrier3,4
1Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, QC, Canada.
Background:
Invasive aspergillosis (IA) is a rare but highly lethal complication after orthotopic liver transplantation (OLT). Targeted antifungal prophylaxis has been proposed as a strategy to prevent IA among orthotopic liver transplant recipient (OLTr), but limited data are available to support its efficacy.
Method:
We conducted a single-center, retrospective, before and after cohort study, comparing IA incidences among OLTr who did not receive antifungal prophylaxis after transplantation (cohort 1) to OLTr who received targeted antifungal prophylaxis after liver transplantation (cohort 2). Patients in cohort 2 received caspofungin prophylaxis if they presented one of the following risk factors: retransplantation, acute liver failure, dialysis, or Aspergillus colonization prior to transplantation. The primary outcome was IA at 90 days after transplantation.
Results:
A total of 391 OLTr were included in the study; 181 patients in the cohort 1 (no prophylaxis) and 210 patients in the cohort 2 (targeted prophylaxis). Among patients in cohort 2, 19% (40/ 210) were considered at high risk for IA and 85% (34/40) of those received caspofungin prophylaxis. The incidence of IA at 90 days was 3.3% (6/ 181) and 0.5% (1/ 210), in cohort 1 and 2, respectively (OR 0.14; 95%CI 0.01-0.83; P = .03). Ninety-day mortality was similar among the two cohorts (3.9% (7/181) and 2.4% (5/210) in cohort 1 and 2, respectively (OR 0.61; 95% 0.18-1.93; P = .40)). The 90-day mortality among the OLTs with IA was 71% (5/7).
Conclusion:
Targeted caspofungin prophylaxis was associated with lower rate of IA.
Insights
Targeted caspofungin prophylaxis significantly reduced invasive aspergillosis (IA) in liver transplant recipients. This strategy offers a promising approach to prevent IA, a serious complication after orthotopic liver transplantation (OLT).
Area of Science:
- Medical Mycology
- Transplantation Immunology
- Infectious Diseases
Background:
- Invasive aspergillosis (IA) is a life-threatening complication in orthotopic liver transplant (OLT) recipients.
- Limited evidence exists on the effectiveness of antifungal prophylaxis for preventing IA in this patient population.
Purpose of the Study:
- To evaluate the efficacy of targeted antifungal prophylaxis in reducing IA incidence after OLT.
- To compare IA rates between OLT recipients with and without targeted prophylaxis.
Main Methods:
- A retrospective, single-center, before-and-after cohort study was conducted.
- Two cohorts were compared: those without prophylaxis and those receiving targeted caspofungin prophylaxis based on risk factors (retransplantation, acute liver failure, dialysis, or Aspergillus colonization).
- The primary outcome was IA incidence at 90 days post-transplantation.
Main Results:
- The incidence of IA at 90 days was significantly lower in the targeted prophylaxis group (0.5%) compared to the no prophylaxis group (3.3%) (OR 0.14; P = .03).
- Ninety-day mortality rates were similar between the groups (2.4% vs. 3.9%).
- Mortality among OLT recipients with IA was high (71%).
Conclusions:
- Targeted caspofungin prophylaxis is associated with a reduced rate of invasive aspergillosis in liver transplant recipients.
- This prophylactic strategy appears effective in preventing a severe complication post-OLT.
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