Fluconazole prevents invasive fungal infections in ortohotopic liver transplant recipients utilizing postoperative systemic antifungal prophylaxis.
Fluconazole, is justified among those at high risk for invasive fungal infections.
The use of postoperative antifungal prophylaxis for low-risk ortohotopic liver transplant recipients is widely practiced.
However, this is not universally accepted nor supported by data.
Dr Pappasa and colleagues conducted a prospective observational study among 200 orthotopic liver transplant recipients.
The transplant recipients were at low risk for invasive fungal infections, and did not receive postoperative antifungal prophylaxis.
|2% of invasive fungal infections were due to Candida spp., and preventable by fluconazole|
|American Journal of Transplantation|
Patients were considered low risk if they had 1 or more of various conditions, including choledochojejunostomy, anastomosis, or retransplantation.
Intra-operative administration of 40 blood products or more, or return to the operating room for intra-abdominal bleeding was considered low risk.
The team considered patients returning to the operating room for anastomotic leak or vascular insufficiency as low risk.
In addition, using preoperative serum creatinine of 2 mg/dL or more, and perioperative Candida colonization was considered low risk.
The researchers followed 193 patients for 100 days post-transplantation for evidence of invasive fungal infections.
Of 193 eligible patients, 4% developed an invasive fungal infection.
The researchers found that 2% of invasive fungal infections were due to Candida spp. and potentially preventable by standard fluconazole prophylaxis.
The team noted that a further 2% developed invasive aspergillosis; and 1 patient developed late onset disseminated cryptococcosis.
Dr Pappasa's team concludes, “Liver transplant recipients at low risk for invasive fungal infections can be identified utilizing pre-determined criteria.”
“Post-transplantation antifungal prophylaxis can be routinely withheld in these patients.”