Micafungin versus amphotericin b lipid complex for the prevention of invasive fungal infections in high-risk liver transplant recipients
Journal
Transplantation
Journal Volume
96
Journal Issue
6
Pages
573-578
Date Issued
2013
Author(s)
Abstract
BACKGROUND: Limited data exist regarding echinocandins as antifungal prophylaxis in liver transplant recipients. METHODS: The efficacy and safety of targeted prophylaxis with micafungin or amphotericin B lipid complex (ABLC) was assessed in a sequential cohort of high-risk patients (posttransplantation dialysis, retransplantation, or reoperation) and compared with those without high risk who did not receive prophylaxis. Outcomes were assessed at 90 days. RESULTS: Micafungin versus ABLC recipients were older (P=0.0065) and more likely to have hepatocellular carcinoma (P=0.025). High-risks, that is, dialysis (55.6% vs. 79.2%), retransplantation (5.6% vs. 12.5%), and reoperation (38.9% vs. 20.8%) did not differ between the two groups. Invasive fungal infections developed in 11.1% (2 of 18) of micafungin recipients, 8.3% (2 of 24) of ABLC recipients, and 3% (7 of 234) of patients without high risks (P=0.12). In nondialyzed patients, ABLC versus micafungin recipients had significantly higher serum creatinine on day 14 (P=0.04). However, renal and hepatic function, rejection, graft loss, and mortality did not differ for the two groups on day 90. CONCLUSIONS: Targeted prophylaxis with micafungin or ABLC decreased the risk of mycoses in high-risk recipients compared with that in low-risk recipients. Compared with ABLC, however, micafungin appeared to be associated with lower early-renal dysfunction and no additional risk of hepatic dysfunction. Copyright ? 2013 by Lippincott Williams & Wilkins.
SDGs
Other Subjects
amphotericin B lipid complex; ampicillin; cefotaxime; corticosteroid; creatinine; methylprednisolone; micafungin; prednisone; sulfamethoxazole; tacrolimus; trimethoprim; adult; age distribution; article; Candida albicans; Candida glabrata; Clavispora lusitaniae; clinical article; cohort analysis; controlled study; creatinine blood level; dialysis; drug dose reduction; drug efficacy; drug safety; female; fungal colonization; graft failure; graft recipient; high risk population; human; kidney function; liver cell carcinoma; liver function; liver graft rejection; liver transplantation; low drug dose; low risk population; male; mortality; outcome assessment; pneumocystosis; postoperative care; priority journal; reoperation; retransplantation; risk reduction; systemic mycosis; Amphotericin B; Antifungal Agents; Chi-Square Distribution; Drug Administration Schedule; Echinocandins; Female; Graft Rejection; Humans; Immunocompromised Host; Kidney Diseases; Lipopeptides; Liver Transplantation; Male; Middle Aged; Mycoses; Premedication; Renal Dialysis; Reoperation; Risk Factors; Time Factors; Treatment Outcome
Type
journal article