title: Micafungin versus amphotericin B lipid complex for the prevention of invasive fungal infections in high-risk liver transplant recipients.
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.
authors.affiliation: 1 Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. 2 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. 3 University of Pittsburgh, Pittsburgh, PA. 4 Address correspondence to: Nina Singh, M.D., Infectious Diseases Section, Veterans Affairs Medical Center, University Drive C, Pittsburgh, PA 15240.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cacciarelli
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host; D007674:Kidney Diseases / Q000139:chemically induced / Q000628:therapy; D055666:Lipopeptides / Q000008:administration & dosage* / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D011292:Premedication; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077551:Micafungin