title: Efficacy and cost-effectiveness of voriconazole prophylaxis for prevention of invasive aspergillosis in high-risk liver transplant recipients.
abstract: Aspergillus infection remains a significant and deadly complication after liver transplantation (LT). We sought to determine whether the antifungal prophylactic use of voriconazole reduces the incidence of invasive aspergillosis (IA) in high-risk LT recipients without prohibitively increasing cost. During the study era (April 2008 to April 2014), 339 deceased donor LTs were performed. Of those patients, 174 high-risk recipients were administered antifungal prophylaxis with voriconazole. The median biological Model for End-Stage Liver Disease score at the time of LT was 33 (range, 18-49) with 56% requiring continuous renal replacement therapy and 50% requiring ventilatory support immediately before transplantation. Diagnosis of IA was stratified as proven, probable, or possible according to previously published definitions. No IA was documented in patients receiving voriconazole prophylaxis. At 90 days after LT, the institutional cost of prophylaxis was $5324 or 5.6% of the predicted cost associated with post-LT aspergillosis. There was no documentation of resistant strains isolated from any recipient who received voriconazole. In conclusion, these data suggest that voriconazole prophylaxis is safe, clinically effective, and cost-effective in high-risk LT recipients.
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Julius
authors.initials: J
authors.lastname: Balogh
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Gordon Burroughs
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Maha
authors.initials: M
authors.lastname: Boktour
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Samir
authors.initials: S
authors.lastname: Patel
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Ashish
authors.initials: A
authors.lastname: Saharia
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Ochoa
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Hepatology.
authors.forename: Robert
authors.initials: R
authors.lastname: McFadden
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Hepatology.
authors.forename: David W
authors.initials: DW
authors.lastname: Victor
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Hepatology.
authors.forename: Victor
authors.initials: V
authors.lastname: Ankoma-Sey
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Hepatology.
authors.forename: Joseph
authors.initials: J
authors.lastname: Galati
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Hepatology.
authors.forename: Howard P
authors.initials: HP
authors.lastname: Monsour
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Infectious Disease, Department of Medicine, Houston Methodist Hospital, Houston, TX.
authors.forename: Victor
authors.initials: V
authors.lastname: Fainstein
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: Xian C
authors.initials: XC
authors.lastname: Li
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Infectious Disease, Department of Medicine, Houston Methodist Hospital, Houston, TX.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Grimes
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
authors.affiliation: MD Anderson Cancer Center, University of Texas, Houston, TX.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aloia
authors.affiliation: Sherrie and Alan Conover Center for Liver Disease and Transplantation.|Divisions of Transplantation, Department of Surgery.
authors.forename: R Mark
authors.initials: RM
authors.lastname: Ghobrial
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000191:economics / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D065819:Voriconazole / Q000191:economics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole