Background: The extent to which antifungal prophylaxis is employed after liver transplantation and the approaches used for such preventive strategies is not well defined. Methods: Survey conducted (between Dec 06- Mar 07) via an electronic survey questionnaire sent to all active liver transplant programs in North America (102 in U.S and 4 in Canada). Results: 67 centers (63%) completed the survey;70% performed > 50 liver transplants annually. 91% of the centers used antifungal prophylaxis; 72% targeted it towards high-risk patients and 28% used universal prophylaxis.Universal prophylaxis was directed towards Candida in 88% and 86% of the sites used fluconazole (FLU).Top 3 choices for mould-active agents used for universal prophylaxis were the echinocandins (41%), voriconazole (25%), and a polyene (18%). Leading indications for targeted prophylaxis were retransplantation ( 81%), reexploration ( 65%), and renal replacement therapy (44%).Targeted prophylaxis was directed towards Candida (65%), and Candida and Aspergillus (26%).Top 3 choices of mould-active agents for targeted prophylaxis were echinocandins (78%), polyenes ( AmB or its lipid formulations, 43%), and voriconazole (37%).49% of the centers used targeted prophylaxis for the initial hospital stay only. FLU was the most commonly used agent for universal and targeted prophylaxis; FLU vs non-FLU use was associated with higher reported rate of mould infections (aspergillosis, zygomycosis, and scedosporiosis , RR 1.5, 95% CI, 1.0-2.2, p=.04). Conclusions: A vast majority of the centers surveyed employ antifungal prophylaxis in liver transplant recipients.The impact of antifungal prophylactic practices in influencing the rates and spectrum of invasive mycoses in liver transplant recipients warrants assessment.
Full conference title:
47th Interscience Conference on Antimicrobial agents and Chemotherapy
- ICAAC 47th