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Invasive Fungal Infections in Low‐Risk Liver Transplant Recipients: A Multi‐Center Prospective Observational Study
Author(s) -
Pappas P. G.,
Andes D.,
Schuster M.,
Hadley S.,
Rabkin J.,
Merion R. M.,
Kauffman C. A.,
Huckabee C.,
Cloud G. A.,
Dismukes W. E.,
Karchmer A. W.
Publication year - 2006
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01176.x
Subject(s) - medicine , fluconazole , perioperative , liver transplantation , observational study , surgery , cryptococcosis , aspergillosis , transplantation , mycosis , intensive care medicine , antifungal , immunology , dermatology
Prevention of invasive fungal infections (IFIs) in orthotopic liver transplant (OLT) recipients utilizing postoperative systemic antifungal prophylaxis, typically with fluconazole, is justified among those at high risk for IFI. Use of postoperative antifungal prophylaxis for low‐risk OLT recipients is widely practiced but not universally accepted nor supported by data. We conducted a prospective observational study among 200 OLT recipients who were at low risk for IFI and did not receive postoperative antifungal prophylaxis. Patients were considered low risk if they had ≤1 of the following conditions: choledochojejunostomy anastomosis; retransplantation; intra‐operative administration of ≥units of 40 blood products or return to the operating room for intra‐abdominal bleeding; return to the operating room for anastomotic leak or vascular insufficiency; preoperative serum creatinine of ≥2 mg/dL; and perioperative Candida colonization. Patients were followed 100 d post‐transplantation for evidence of IFI. Of 193 eligible patients, 7 (4%) developed an IFI. Three (2%) IFIs were due to Candida spp. and potentially preventable by standard fluconazole prophylaxis. Three patients developed invasive aspergillosis; one developed late onset disseminated cryptococcosis. Liver transplant recipients at low risk for IFI can be identified utilizing pre‐determined criteria, and post‐transplantation antifungal prophylaxis can be routinely withheld in these patients.