PittsburghV1, Main, Exploration, bibRecord, 001011

Targeted versus Universal Antifungal Prophylaxis among Liver Transplant Recipients

Identifieur interne : 001011 ( Main/Exploration ); précédent : 001010; suivant : 001012

Targeted versus Universal Antifungal Prophylaxis among Liver Transplant Recipients

Auteurs : Ga Eschenauer [États-Unis] ; Ej Kwak [États-Unis] ; A. Humar [États-Unis] ; Ba Potoski [États-Unis] ; Lg Clarke [États-Unis] ; Rk Shields [États-Unis] ; R. Abdel-Massih [États-Unis] ; Fp Silveira [États-Unis] ; P. Vergidis [États-Unis] ; Cj Clancy [États-Unis] ; Mh Nguyen [États-Unis]

Source :

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [ 1600-6135 ] ; 2014.

RBID : PMC:4365781

Descripteurs français

KwdFr :
- Adulte, Adulte d'âge moyen, Algorithmes, Antifongiques (usage thérapeutique), Complications postopératoires, Donneurs de tissus, Facteurs de risque, Femelle, Humains, Maladies du foie (), Maladies du foie (microbiologie), Mycoses (), Mycoses (microbiologie), Mycoses (épidémiologie), Mâle, Pronostic, Receveurs de transplantation, Rejet du greffon (microbiologie), Rejet du greffon (épidémiologie), Sujet immunodéprimé, Sujet âgé, Survie du greffon, Transplantation hépatique (effets indésirables), États-Unis d'Amérique (épidémiologie), Études de suivi, Études rétrospectives.
MESH :
- effets indésirables : Transplantation hépatique.
- microbiologie : Maladies du foie, Mycoses, Rejet du greffon.
- usage thérapeutique : Antifongiques.
- épidémiologie : Mycoses, Rejet du greffon, États-Unis d'Amérique.
- Adulte, Adulte d'âge moyen, Algorithmes, Complications postopératoires, Donneurs de tissus, Facteurs de risque, Femelle, Humains, Maladies du foie, Mycoses, Mâle, Pronostic, Receveurs de transplantation, Sujet immunodéprimé, Sujet âgé, Survie du greffon, Études de suivi, Études rétrospectives.
Wicri :
- geographic : États-Unis.

English descriptors

KwdEn :
- Adult, Aged, Algorithms, Antifungal Agents (therapeutic use), Female, Follow-Up Studies, Graft Rejection (epidemiology), Graft Rejection (microbiology), Graft Survival, Humans, Immunocompromised Host, Liver Diseases (complications), Liver Diseases (microbiology), Liver Diseases (surgery), Liver Transplantation (adverse effects), Male, Middle Aged, Mycoses (epidemiology), Mycoses (microbiology), Mycoses (prevention & control), Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Tissue Donors, Transplant Recipients, United States (epidemiology).
MESH :
- chemical , therapeutic use : Antifungal Agents.
- geographic , epidemiology : United States.
- adverse effects : Liver Transplantation.
- complications : Liver Diseases.
- epidemiology : Graft Rejection, Mycoses.
- microbiology : Graft Rejection, Liver Diseases, Mycoses.
- prevention & control : Mycoses.
- surgery : Liver Diseases.
- Adult, Aged, Algorithms, Female, Follow-Up Studies, Graft Survival, Humans, Immunocompromised Host, Male, Middle Aged, Postoperative Complications, Prognosis, Retrospective Studies, Risk Factors, Tissue Donors, Transplant Recipients.

Abstract

Guidelines recommend targeted antifungal prophylaxis for liver transplant recipients based on tiers of risk, rather than universal prophylaxis. The feasibility and efficacy of tiered, targeted prophylaxis is not well-established. We performed a retrospective study of liver transplant recipients who received targeted prophylaxis (n=145; voriconazole (54%), fluconazole (8%), no antifungal (38%))vs. universal voriconazole prophylaxis (n=237). Median durations of targeted and universal prophylaxis were 11 and 6 days, respectively (p<0.0001). The incidence of invasive fungal infections (IFIs)in targeted and universal groups was 6.9% and 4.2% (p= 0.34). Overall, intra-abdominal candidiasis (73%) was the most common IFI. Post-transplant bile leaks (p=0.001) and living donor transplants (p=0.04) were independent risk factors for IFI. IFIs occurred in 6% of high-risk transplants who received prophylaxis and 4% of low-risk transplants who did not receive prophylaxis (p=1.0).Mortality rates (100 days) were 10% (targeted) and 7% (universal) (p=0.26); attributable mortality due to IFI was 10%. Compliance with prophylaxis recommendations was 97%. Prophylaxis was discontinued for toxicity in 2% of patients. Targeted antifungal prophylaxis in liver transplant recipients was feasible and safe, effectively prevented IFIs, and reduced the number of patients exposed to antifungals. Bile leaks and living donor transplants should be considered high-risk indications for prophylaxis.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365781

DOI: 10.1111/ajt.12993
PubMed: 25359455
PubMed Central: 4365781

Affiliations:

Le document en format XML

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 Universal Antifungal Prophylaxis among Liver Transplant Recipients</title>
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 Universal Antifungal Prophylaxis among Liver Transplant Recipients</title>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Algorithms</term>
<term>Antifungal Agents (therapeutic use)</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Graft Rejection (epidemiology)</term>
<term>Graft Rejection (microbiology)</term>
<term>Graft Survival</term>
<term>Humans</term>
<term>Immunocompromised Host</term>
<term>Liver Diseases (complications)</term>
<term>Liver Diseases (microbiology)</term>
<term>Liver Diseases (surgery)</term>
<term>Liver Transplantation (adverse effects)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Mycoses (epidemiology)</term>
<term>Mycoses (microbiology)</term>
<term>Mycoses (prevention & control)</term>
<term>Postoperative Complications</term>
<term>Prognosis</term>
<term>Retrospective Studies</term>
<term>Risk Factors</term>
<term>Tissue Donors</term>
<term>Transplant Recipients</term>
<term>United States (epidemiology)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Algorithmes</term>
<term>Antifongiques (usage thérapeutique)</term>
<term>Complications postopératoires</term>
<term>Donneurs de tissus</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Maladies du foie ()</term>
<term>Maladies du foie (microbiologie)</term>
<term>Mycoses ()</term>
<term>Mycoses (microbiologie)</term>
<term>Mycoses (épidémiologie)</term>
<term>Mâle</term>
<term>Pronostic</term>
<term>Receveurs de transplantation</term>
<term>Rejet du greffon (microbiologie)</term>
<term>Rejet du greffon (épidémiologie)</term>
<term>Sujet immunodéprimé</term>
<term>Sujet âgé</term>
<term>Survie du greffon</term>
<term>Transplantation hépatique (effets indésirables)</term>
<term>États-Unis d'Amérique (épidémiologie)</term>
<term>Études de suivi</term>
<term>Études rétrospectives</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antifungal Agents</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>United States</term>
</keywords>
<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Liver Transplantation</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Liver Diseases</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Transplantation hépatique</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Graft Rejection</term>
<term>Mycoses</term>
</keywords>
<keywords scheme="MESH" qualifier="microbiologie" xml:lang="fr"><term>Maladies du foie</term>
<term>Mycoses</term>
<term>Rejet du greffon</term>
</keywords>
<keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Graft Rejection</term>
<term>Liver Diseases</term>
<term>Mycoses</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Mycoses</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Liver Diseases</term>
</keywords>
<keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antifongiques</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Mycoses</term>
<term>Rejet du greffon</term>
<term>États-Unis d'Amérique</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Algorithms</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Graft Survival</term>
<term>Humans</term>
<term>Immunocompromised Host</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Postoperative Complications</term>
<term>Prognosis</term>
<term>Retrospective Studies</term>
<term>Risk Factors</term>
<term>Tissue Donors</term>
<term>Transplant Recipients</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Algorithmes</term>
<term>Complications postopératoires</term>
<term>Donneurs de tissus</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Maladies du foie</term>
<term>Mycoses</term>
<term>Mâle</term>
<term>Pronostic</term>
<term>Receveurs de transplantation</term>
<term>Sujet immunodéprimé</term>
<term>Sujet âgé</term>
<term>Survie du greffon</term>
<term>Études de suivi</term>
<term>Études rétrospectives</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>États-Unis</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p id="P3">Guidelines recommend targeted antifungal prophylaxis for liver transplant recipients based on tiers of risk, rather than universal prophylaxis. The feasibility and efficacy of tiered, targeted prophylaxis is not well-established. We performed a retrospective study of liver transplant recipients who received targeted prophylaxis (n=145; voriconazole (54%), fluconazole (8%), no antifungal (38%))<italic>vs</italic>
. universal voriconazole prophylaxis (n=237). Median durations of targeted and universal prophylaxis were 11 and 6 days, respectively (p<0.0001). The incidence of invasive fungal infections (IFIs)in targeted and universal groups was 6.9% and 4.2% (p= 0.34). Overall, intra-abdominal candidiasis (73%) was the most common IFI. Post-transplant bile leaks (p=0.001) and living donor transplants (p=0.04) were independent risk factors for IFI. IFIs occurred in 6% of high-risk transplants who received prophylaxis and 4% of low-risk transplants who did not receive prophylaxis (p=1.0).Mortality rates (100 days) were 10% (targeted) and 7% (universal) (p=0.26); attributable mortality due to IFI was 10%. Compliance with prophylaxis recommendations was 97%. Prophylaxis was discontinued for toxicity in 2% of patients. Targeted antifungal prophylaxis in liver transplant recipients was feasible and safe, effectively prevented IFIs, and reduced the number of patients exposed to antifungals. Bile leaks and living donor transplants should be considered high-risk indications for prophylaxis.</p>
</div>
</front>
</TEI>
<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Pennsylvanie</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Eschenauer, Ga" sort="Eschenauer, Ga" uniqKey="Eschenauer G" first="Ga" last="Eschenauer">Ga Eschenauer</name>
</region>
<name sortKey="Abdel Massih, R" sort="Abdel Massih, R" uniqKey="Abdel Massih R" first="R" last="Abdel-Massih">R. Abdel-Massih</name>
<name sortKey="Abdel Massih, R" sort="Abdel Massih, R" uniqKey="Abdel Massih R" first="R" last="Abdel-Massih">R. Abdel-Massih</name>
<name sortKey="Clancy, Cj" sort="Clancy, Cj" uniqKey="Clancy C" first="Cj" last="Clancy">Cj Clancy</name>
<name sortKey="Clarke, Lg" sort="Clarke, Lg" uniqKey="Clarke L" first="Lg" last="Clarke">Lg Clarke</name>
<name sortKey="Clarke, Lg" sort="Clarke, Lg" uniqKey="Clarke L" first="Lg" last="Clarke">Lg Clarke</name>
<name sortKey="Eschenauer, Ga" sort="Eschenauer, Ga" uniqKey="Eschenauer G" first="Ga" last="Eschenauer">Ga Eschenauer</name>
<name sortKey="Humar, A" sort="Humar, A" uniqKey="Humar A" first="A" last="Humar">A. Humar</name>
<name sortKey="Kwak, Ej" sort="Kwak, Ej" uniqKey="Kwak E" first="Ej" last="Kwak">Ej Kwak</name>
<name sortKey="Kwak, Ej" sort="Kwak, Ej" uniqKey="Kwak E" first="Ej" last="Kwak">Ej Kwak</name>
<name sortKey="Nguyen, Mh" sort="Nguyen, Mh" uniqKey="Nguyen M" first="Mh" last="Nguyen">Mh Nguyen</name>
<name sortKey="Nguyen, Mh" sort="Nguyen, Mh" uniqKey="Nguyen M" first="Mh" last="Nguyen">Mh Nguyen</name>
<name sortKey="Potoski, Ba" sort="Potoski, Ba" uniqKey="Potoski B" first="Ba" last="Potoski">Ba Potoski</name>
<name sortKey="Potoski, Ba" sort="Potoski, Ba" uniqKey="Potoski B" first="Ba" last="Potoski">Ba Potoski</name>
<name sortKey="Potoski, Ba" sort="Potoski, Ba" uniqKey="Potoski B" first="Ba" last="Potoski">Ba Potoski</name>
<name sortKey="Shields, Rk" sort="Shields, Rk" uniqKey="Shields R" first="Rk" last="Shields">Rk Shields</name>
<name sortKey="Shields, Rk" sort="Shields, Rk" uniqKey="Shields R" first="Rk" last="Shields">Rk Shields</name>
<name sortKey="Silveira, Fp" sort="Silveira, Fp" uniqKey="Silveira F" first="Fp" last="Silveira">Fp Silveira</name>
<name sortKey="Vergidis, P" sort="Vergidis, P" uniqKey="Vergidis P" first="P" last="Vergidis">P. Vergidis</name>
</country>
</tree>
</affiliations>
</record>

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Targeted versus Universal Antifungal Prophylaxis among Liver Transplant Recipients

Targeted versus Universal Antifungal Prophylaxis among Liver Transplant Recipients

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