Antifungal prophylaxis in liver transplant recipients: a randomized placebo-controlled study.
The aim of this study was to evaluate the efficacy of two antifungal prophylaxis regimens in liver transplant recipients. One hundred and twenty-nine consecutive recipients were randomized to receive sequential treatment with intravenous liposomal amphotericin B + oral itraconazole, intravenous fluconazole + oral itraconazole, or intravenous and oral placebo. Frequency and incidence of mycotic colonization, local and systemic infection of mycotic origin, causes of death, and possible risk factors for mycotic infection were evaluated. The incidence of mycotic colonization was higher in the placebo group ( P<0.01), but there was no significant difference in the incidence of infection between the three groups. Pre-transplant colonization, severity of liver disease, and graft rejection were all risk factors for the development of fungal infection. The routine use of antifungal prophylaxis for all liver transplant recipients does not seem to be justified.
Biancofiore
Gianni
G
Department of Anesthesia and Intensive Care No.1, Post-surgical and Transplant I.C.U., Azienda Ospedaliera Pisana, Ospedale di Cisanello, Via Paradisa 2, 56100 Pisa, Italy. g.biancofiore@med.unipi.it
Bindi
Maria L
ML
Baldassarri
Rubia
R
Romanelli
Anna Maria
AM
Catalano
Gabriele
G
Filipponi
Franco
F
Vagelli
Antonio
A
Mosca
Franco
F
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000453:epidemiology; D002177:Candidiasis / Q000453:epidemiology; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017964:Itraconazole / Q000627:therapeutic use; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000517:prevention & control*; D010919:Placebos; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016019:Survival Analysis
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D010919:Placebos; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole