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. 2021 Aug;23(4):e13568.
doi: 10.1111/tid.13568. Epub 2021 Feb 1.

Targeted caspofungin prophylaxis for invasive aspergillosis in high-risk liver transplant recipients, a single-center experience

Arpita Chakravarti  1 , Guillaume Butler-Laporte  2 , Francois Martin Carrier  3   4 , Marc Bilodeau  5 , Genevieve Huard  5 , Daniel Corsilli  4   5 , Patrice Savard  1 , Me-Linh Luong  1
Affiliations

Targeted caspofungin prophylaxis for invasive aspergillosis in high-risk liver transplant recipients, a single-center experience

Arpita Chakravarti et al. Transpl Infect Dis. 2021 Aug.

Abstract

Background: Invasive aspergillosis (IA) is a rare but highly lethal complication after orthotopic liver transplantation (OLT). Targeted antifungal prophylaxis has been proposed as a strategy to prevent IA among orthotopic liver transplant recipient (OLTr), but limited data are available to support its efficacy.

Method: We conducted a single-center, retrospective, before and after cohort study, comparing IA incidences among OLTr who did not receive antifungal prophylaxis after transplantation (cohort 1) to OLTr who received targeted antifungal prophylaxis after liver transplantation (cohort 2). Patients in cohort 2 received caspofungin prophylaxis if they presented one of the following risk factors: retransplantation, acute liver failure, dialysis, or Aspergillus colonization prior to transplantation. The primary outcome was IA at 90 days after transplantation.

Results: A total of 391 OLTr were included in the study; 181 patients in the cohort 1 (no prophylaxis) and 210 patients in the cohort 2 (targeted prophylaxis). Among patients in cohort 2, 19% (40/ 210) were considered at high risk for IA and 85% (34/40) of those received caspofungin prophylaxis. The incidence of IA at 90 days was 3.3% (6/ 181) and 0.5% (1/ 210), in cohort 1 and 2, respectively (OR 0.14; 95%CI 0.01-0.83; P = .03). Ninety-day mortality was similar among the two cohorts (3.9% (7/181) and 2.4% (5/210) in cohort 1 and 2, respectively (OR 0.61; 95% 0.18-1.93; P = .40)). The 90-day mortality among the OLTs with IA was 71% (5/7).

Conclusion: Targeted caspofungin prophylaxis was associated with lower rate of IA.

Keywords: Fungal infection; aspergillosis; caspofungin; echinocandin; liver transplantation; prophylaxis.

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References

REFERENCES

    1. Pappas P, Alexander B, Andes D, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network (TRANSNET). Clin Infect Dis. 2010;50(8):1101-1111. https://doi.org/10.1086/651262
    1. Neofytos D, Fishman JA, Horn D, et al. Epidemiology and outcome of invasive fungal infections in solid organ transplant recipients. Transpl Infect Dis. 2010;12(3):220-229. https://doi.org/10.1111/j.1399-3062.2010.00492.x
    1. Singh N, Arnow PM, Bonham A, et al. Invasive aspergillosis in liver transplant recipients in the 1990s. Transplantation. 1990s;64(5):716-720. https://doi.org/10.1097/00007890-199709150-00009
    1. Winston DJ, Busuttil RW. Randomized controlled trial of oral itraconazole solution versus intravenous/oral fluconazole for prevention of fungal infections in liver transplant recipients. Transplantation. 2002;74(5):688-695. https://doi.org/10.1097/00007890-200209150-00017
    1. Fortún J, Martín-Dávila P, Montejo M, et al. Prophylaxis with caspofungin for invasive fungal infections in high-risk liver transplant recipients. Transplantation. 2009;87(3):424-435. https://doi.org/10.1097/TP.0b013e3181932e76

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