title: Invasive Candida infections in low risk liver transplant patients given no antifungal prophylaxis in the post-operative period.
abstract: BACKGROUND
  In recent years the incidence of invasive fungal infections (IFIs) in post liver transplant (LT) has reduced to about 5%, however the majority of IFIs develops early in the post-transplant course. Candida species are the most frequent causative pathogens followed by Aspergillus species. Mortality for invasive candidiasis is still 40-50%. For this reason universal prophylaxis is still considered useful and is adopted by different LT centers, although it is not justified by available data. The aim of study is to evaluate Candida infection incidence and mortality in low risk patients and therefore not subjected to antifungal prophylaxis in the immediate post-LT.
  
  
  METHODS
  The patient is defined low risk if without any risk factor for IFIs as reported in literature and according to our center protocol described below. We analyzed retrospectively the records (with 90 days follow-up) of all adult patients underwent to LT at our center in 2011-2012.
  
  
  RESULTS
  At our center between 2011 and 2012, 247 LT in 232 adult patients were performed: 137 patients (59%) received prophylaxis with Amphotericin B lipid complex or liposomal Amphotericin B, 95 patients (41%) didn't receive any prophylaxis. In these latter patients was observed only one case of Candida oesophagitis at the second month post-LT. The incidence of invasive candidiasis was 0%, and there wasn't mortality ascribed to Candida infection.
  
  
  CONCLUSIONS
  It is possible to identify low risk patients for IFIs post-LT and the no prophylaxis policy in the early LT course appears safe and feasible.
authors.affiliation: Liver Transplant Center, Anesthesia and Intensive Care Unit 3, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy. Electronic address: brunalavezzo@libero.it.
authors.forename: B
authors.initials: B
authors.lastname: Lavezzo
authors.affiliation: Liver Transplant Center, Anesthesia and Intensive Care Unit 3, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Stratta
authors.affiliation: Liver Transplant Center, Anesthesia and Intensive Care Unit 3, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Ballaris
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: Liver Transplant Center, Anesthesia and Intensive Care Unit 3, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Panio
authors.affiliation: Liver Transplant Center, Anesthesia and Intensive Care Unit 3, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: P P
authors.initials: PP
authors.lastname: Donadio
authors.affiliation: Liver Transplant Center, General Surgery Unit, A.O. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B