BACKGROUND: Invasive fungal infections (IFI) remain a significant cause of morbidity and mortality in orthotopic liver transplantation (OLT) recipients. In this retrospective study, the outcomes of a protocol using once weekly fluconazole for 3 months after OLT in low- and high-risk patients were reviewed. METHODS: In total, 221 OLTs were evaluated in the 3-year period after institution of the new protocol to determine the incidence of IFI within 6 months post-OLT. RESULTS: In this cohort, 11 IFIs developed during the 6-month post-transplant period, with the majority being non-albicans Candida. High-risk patients had a greater rate of IFI (16.7% versus 3.4%, P = 0.038) and a significantly longer intensive unit care (ICU) and hospital lengths of stay compared with low-risk patients. Patient and graft survival were similar between the groups. Our patient population appeared to be at low risk for IFI, with 92% of the entire cohort considered low risk. DISCUSSION: Given the low incidence of IFI in the low-risk group and the possibility of such protocol selecting out for fluconazole-resistant fungi, the use of weekly fluconazole for 3 months may not be justifiable in low-risk OLT recipients. Given the increased resource utilization observed with IFI, further examination of a more intensive prophylactic strategy in high-risk patients may be warranted.
BACKGROUND: Invasive fungal infections (IFI) remain a significant cause of morbidity and mortality in orthotopic liver transplantation (OLT) recipients. In this retrospective study, the outcomes of a protocol using once weekly fluconazole for 3 months after OLT in low- and high-risk patients were reviewed. METHODS: In total, 221 OLTs were evaluated in the 3-year period after institution of the new protocol to determine the incidence of IFI within 6 months post-OLT. RESULTS: In this cohort, 11 IFIs developed during the 6-month post-transplant period, with the majority being non-albicans Candida. High-risk patients had a greater rate of IFI (16.7% versus 3.4%, P = 0.038) and a significantly longer intensive unit care (ICU) and hospital lengths of stay compared with low-risk patients. Patient and graft survival were similar between the groups. Our patient population appeared to be at low risk for IFI, with 92% of the entire cohort considered low risk. DISCUSSION: Given the low incidence of IFI in the low-risk group and the possibility of such protocol selecting out for fluconazole-resistant fungi, the use of weekly fluconazole for 3 months may not be justifiable in low-risk OLT recipients. Given the increased resource utilization observed with IFI, further examination of a more intensive prophylactic strategy in high-risk patients may be warranted.
Authors: R Patel; D Portela; A D Badley; W S Harmsen; J J Larson-Keller; D M Ilstrup; M R Keating; R H Wiesner; R A Krom; C V Paya Journal: Transplantation Date: 1996-10-15 Impact factor: 4.939
Authors: P G Pappas; D Andes; M Schuster; S Hadley; J Rabkin; R M Merion; C A Kauffman; C Huckabee; G A Cloud; W E Dismukes; A W Karchmer Journal: Am J Transplant Date: 2006-02 Impact factor: 8.086
Authors: Joseph Menzin; Juliana L Meyers; Mark Friedman; Jonathan R Korn; John R Perfect; Amelia A Langston; Robert P Danna; George Papadopoulos Journal: Am J Infect Control Date: 2010-10-20 Impact factor: 2.918
Authors: J Briegel; H Forst; B Spill; A Haas; B Grabein; M Haller; E Kilger; K W Jauch; K Maag; G Ruckdeschel Journal: Eur J Clin Microbiol Infect Dis Date: 1995-05 Impact factor: 3.267
Authors: Alberto Ferrarese; Annamaria Cattelan; Umberto Cillo; Enrico Gringeri; Francesco Paolo Russo; Giacomo Germani; Martina Gambato; Patrizia Burra; Marco Senzolo Journal: World J Gastroenterol Date: 2020-12-21 Impact factor: 5.742