A-13
ANTIFUNGAL PROPHYLAXIS IN LIVER TRANSPLANT RECIPIENTS: RISK
FACTORS AND MANAGEMENT
Shyh G*, Yi G, Marfo K
Montefiore Medical Center Department of Pharmacy, 111 E 210th Street, Bronx, NY
10467
Objective. The study aims to establish institutional antifungal prophylactic regimen in
liver transplant recipients by classifying independent risk factors of post-transplant fungal
infections and identifying the optimal antifungal therapy.
Methods. This is an IRB-approved retrospective single center study, examining liver
transplant patients from December 2008 to June 2012 at the Montefiore Medical Center,
Bronx, NY. Baseline patient characteristics such as age, gender, ethnicity, underlying
diseases, and types of liver donor will be assessed using the Student’s t-test. Precipitating
factors of post-liver transplant fungal infections will be evaluated by collecting donor and
recipient’s CMV status, Model for End-Stage Liver Disease (MELD) scores, history of
fungal infections, re-transplantation, post-transplant dialysis, breakthrough fungal
infections post-operatively, other bacterial co-infections, concomitant antibiotics, level of
immunosuppression, fungal infection mortality rate, etc.
In addition, the study will
evaluate antifungal prophylaxis regimen to establish an optimized institutional antifungal
prophylaxis guideline pertaining to the liver transplantation population.
Statistical
analysis will be performed using SPSS (SPSS Inc., Chicago, IL, version 19.0) statistical
program.
Linear regression with multivariate analysis will be used to assess the
independent risk factors of post liver transplant fungal infections. A two-tailed p-value of
smaller than 0.05 is considered to be significant.
Results. This study showed that no fungal infection in the prophylactic group vs. one
invasive aspergillus infection in the non-prophylactic group.
Risk factors which
warranted antifungal prophylaxis included elevation of the MELD score and pretransplant serum creatinine, greater volume of intraoperative blood transfusion,
requirement for pre- and post-transplant dialysis, as well as return-to-OR. In addition,
primarily in the author’s institution, both fluconazole 200 mg once daily or micafungin
100 mg daily for an average of 5 days were employed to prevent post-liver transplant
fungal infections.
Conclusion. Based on this institutional study, antifungal prophylaxis was used routinely
in patients with multiple risk factors, which is consistent with the recommendations in the
literature. Future endeavors may include multicenter prospective enrollment with a larger
patient population or multi-center participation. In the interim, liver transplant recipients
with risk factors such as hemodialysis requirement, intraoperative blood transfusion, high
MELD score, high pre-operative serum creatinine, and requirement to return to OR may
benefit from antifungal prophylaxis with either fluconazole 200 mg daily or micafungin
100 mg daily for an average period of 5 days to prevent post-liver transplant fungal
infections.