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Effect of prophylaxis on fungal infection and costs for high‐risk liver transplant recipients
Author(s) -
Reed Alan,
Herndon Jill Boylston,
Ersoz Nail,
Fujikawa Takahisa,
Schain Denise,
Lipori Paul,
Hemming Alan,
Li Qin,
Shenkman Elizabeth,
Vogel Bruce
Publication year - 2007
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21331
Subject(s) - medicine , amphotericin b , incidence (geometry) , regimen , surgery , relative risk , antifungal , confidence interval , physics , dermatology , optics
We sought to determine whether the prophylactic use of amphotericin B products (conventional amphotericin B and liposomal amphotericin B) reduces the incidence of fungal infections in high‐risk liver transplant recipients, and if so, whether this lowers the cost of care. The study sample comprised 232 adult orthotopic liver transplants performed from 1994 to 2005 at a single center for patients classified as being at high risk for fungal infections. High‐risk patients who received transplants with a prophylaxis regimen of amphotericin B (n = 58 transplants) were compared with high‐risk patients who received no prophylaxis (n = 174 transplants). Fungal infections occurred in 3 transplants (5.17%) of those who received amphotericin B and 28 transplants (16.09%) in those without prophylaxis ( P = 0.0432). Regression models were used to analyze fungal infection and costs for the 232 high‐risk transplants. Failure to offer prophylaxis conferred a 4‐fold greater risk of fungal infection ( P = 0.046) compared with those who received amphotericin B. A fungal infection in a high‐risk recipient increased mean costs by 46.48%. The indirect effect of prophylaxis (operating through infection reduction) is estimated to reduce overall costs in high‐risk patients by 8.73%. Liver Transpl 13: 1743–1750, 2007. © 2007 AASLD.