title: Once weekly fluconazole for antifungal prophylaxis post-liver transplantation.
abstract: BACKGROUND
  Invasive fungal infections (IFI) remain a significant cause of morbidity and mortality in orthotopic liver transplantation (OLT) recipients. In this retrospective study, the outcomes of a protocol using once weekly fluconazole for 3 months after OLT in low- and high-risk patients were reviewed.
  
  
  METHODS
  In total, 221 OLTs were evaluated in the 3-year period after institution of the new protocol to determine the incidence of IFI within 6 months post-OLT.
  
  
  RESULTS
  In this cohort, 11 IFIs developed during the 6-month post-transplant period, with the majority being non-albicans Candida. High-risk patients had a greater rate of IFI (16.7% versus 3.4%, P = 0.038) and a significantly longer intensive unit care (ICU) and hospital lengths of stay compared with low-risk patients. Patient and graft survival were similar between the groups. Our patient population appeared to be at low risk for IFI, with 92% of the entire cohort considered low risk.
  
  
  CONCLUSIONS
  Given the low incidence of IFI in the low-risk group and the possibility of such protocol selecting out for fluconazole-resistant fungi, the use of weekly fluconazole for 3 months may not be justifiable in low-risk OLT recipients. Given the increased resource utilization observed with IFI, further examination of a more intensive prophylactic strategy in high-risk patients may be warranted.
authors: Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
authors: Raelene E
authors: RE
authors: Trudeau
authors: Lyndsey J
authors: LJ
authors: Bowman
authors: Angela R
authors: AR
authors: Wills
authors: Jeffrey S
authors: JS
authors: Crippin
authors: William C
authors: WC
authors: Chapman
authors: Christopher
authors: C
authors: Anderson
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D015725:Fluconazole