Invasive Candidiasis in Liver Transplant Recipients Undergoing Antifungal Prophylaxis

Invasive candidiasis (IC) is the most frequent invasive fungal infection (IFI) affecting liver transplant (LT) recipients. Antifungal prophylaxis (AP) effectively reduces the incidence IFI after LT. However, a considerable proportion of LT recipients undergoing AP are still affected by IC.

To assess the incidence and factors associated with IC in high-risk LT recipients undergoing AP.

Retrospective single-center study including high-risk LT recipients undergoing AP between 2015 and 2020. The primary outcome was the occurrence of IC within the first 90 days after LT. Secondary outcomes included mortality within 30 days of diagnosis of IC and the occurrence of other IFI within 90 days after LT. The basic prophylactic regimen was fluconazole 200 mg/d, with micafungin being an alternative option.

There were 10 cases (5.8%) of IC among 171 high-risk recipients who started AP. Most cases were caused by non-albicans Candida spp. The 30-day mortality rate was 40%. Only 1 case (0.6%) of another IFI (disseminated cryptococcosis) was diagnosed during the study period. IC was more frequent among Black patients (p=0.02), after reoperation (p = .036), and in recipients with a higher count of risk factors for IFI (p = .061). Oppositely, IC was less frequent in patients with a pre-transplant diagnosis of hepatocellular carcinoma (p = .065).

IC occurred in 5.8% of LT recipients undergoing AP and was associated with high mortality. The predictive factors for IC identified in this study may inform the decision to start empirical antifungal therapy in high-risk LT recipients undergoing AP.