title: Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach.
abstract: Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT.Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors.Results. The cumulative hazards and transition probability of "transplantation to fungal infection" were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% (p= 0.052); overall mortality improved from 40.8% to 23.4% (p< 0.001). In the "transplantation to fungal infection" transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34-0.96,p= 0.033). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality.Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections.
authors.affiliation: Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 259, Taiwan; Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Yi-Chan
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 259, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan.
authors.forename: Ting-Shuo
authors.identifier: 0000-0002-2932-6878
authors.initials: TS
authors.lastname: Huang
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Yu-Chao
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Chih-Hsien
authors.identifier: 0000-0002-3110-1598
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Chen-Fang
authors.initials: CF
authors.lastname: Lee
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Ting-Jun
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Hong-Shiue
authors.initials: HS
authors.lastname: Chou
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Kun-Ming
authors.initials: KM
authors.lastname: Chan
authors.affiliation: Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Lee
authors.affiliation: Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; School of Medicine, Chang Gung University, Taoyuan 259, Taiwan; Department of Liver and Transplantation Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 259, Taiwan.
authors.forename: Ruey-Shyang
authors.identifier: 0000-0001-7245-9505
authors.initials: RS
authors.lastname: Soong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000401:mortality* / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011292:Premedication / Q000401:mortality / Q000706:statistics & numerical data; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents