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Targeted versus universal antifungal prophylaxis among liver transplant recipients.

Identifieur interne : 000202 ( PubMed/Checkpoint ); précédent : 000201; suivant : 000203

Targeted versus universal antifungal prophylaxis among liver transplant recipients.

Auteurs : G A Eschenauer [États-Unis] ; E J Kwak ; A. Humar ; B A Potoski ; L G Clarke ; R K Shields ; R. Abdel-Massih ; F P Silveira ; P. Vergidis ; C J Clancy ; M H Nguyen

Source :

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [ 1600-6143 ] ; 2015.

RBID : pubmed:25359455

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 (LT) 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 LT recipients who received targeted prophylaxis (n = 145; voriconazole [VORI; 54%], fluconazole [8%], no antifungal [38%]) versus universal VORI 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. Posttransplant 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 LT 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.

DOI: 10.1111/ajt.12993
PubMed: 25359455

Affiliations:

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to stream PubMed, to step Curation: 000858

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pubmed:25359455

Le document en format XML

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<front><div type="abstract" xml:lang="en">Guidelines recommend targeted antifungal prophylaxis for liver transplant (LT) 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 LT recipients who received targeted prophylaxis (n = 145; voriconazole [VORI; 54%], fluconazole [8%], no antifungal [38%]) versus universal VORI 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. Posttransplant 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 LT 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.</div>
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<ArticleTitle>Targeted versus universal antifungal prophylaxis among liver transplant recipients.</ArticleTitle>
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<Abstract><AbstractText>Guidelines recommend targeted antifungal prophylaxis for liver transplant (LT) 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 LT recipients who received targeted prophylaxis (n = 145; voriconazole [VORI; 54%], fluconazole [8%], no antifungal [38%]) versus universal VORI 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. Posttransplant 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 LT 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.</AbstractText>
<CopyrightInformation>© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.</CopyrightInformation>
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<PMID Version="1">16390401</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2006 Feb;6(2):386-91</RefSource>
<PMID Version="1">16426325</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Clin Infect Dis. 2006 Jul 1;43(1):25-31</RefSource>
<PMID Version="1">16758414</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2006 Oct;6(10):2365-74</RefSource>
<PMID Version="1">16925570</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Pharmacotherapy. 2006 Dec;26(12):1730-44</RefSource>
<PMID Version="1">17125435</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Liver Transpl. 2006 Dec;12(12):1799-804</RefSource>
<PMID Version="1">16741903</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2006 Dec;6(12):3008-16</RefSource>
<PMID Version="1">17062003</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Clin Vaccine Immunol. 2007 Dec;14(12):1550-4</RefSource>
<PMID Version="1">17959819</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2008 Dec;8(12):2569-79</RefSource>
<PMID Version="1">18976306</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Clin Infect Dis. 2008 Jun 15;46(12):1813-21</RefSource>
<PMID Version="1">18462102</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Liver Transpl. 2007 Dec;13(12):1743-50</RefSource>
<PMID Version="1">18044769</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transpl Infect Dis. 2009 Feb;11(1):40-8</RefSource>
<PMID Version="1">19144094</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Clin Infect Dis. 2009 Mar 1;48(5):503-35</RefSource>
<PMID Version="1">19191635</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transplantation. 2009 Feb 15;87(3):424-35</RefSource>
<PMID Version="1">19202450</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Liver Transpl. 2009 Aug;15(8):842-58</RefSource>
<PMID Version="1">19642130</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Gastrointest Endosc. 2009 Sep;70(3):480-7</RefSource>
<PMID Version="1">19555935</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2009 Dec;9 Suppl 4:S173-9</RefSource>
<PMID Version="1">20070678</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Transplant. 2009 Dec;9 Suppl 4:S180-91</RefSource>
<PMID Version="1">20070679</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Antimicrob Agents Chemother. 2010 Feb;54(2):852-9</RefSource>
<PMID Version="1">19933807</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Clin Infect Dis. 2010 Nov 1;51(9):1062-9</RefSource>
<PMID Version="1">20879857</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transplantation. 2013 Sep;96(6):573-8</RefSource>
<PMID Version="1">23842191</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Am J Respir Crit Care Med. 2013 Nov 1;188(9):1100-9</RefSource>
<PMID Version="1">23782027</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>PLoS One. 2014;9(1):e87128</RefSource>
<PMID Version="1">24475243</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>J Antimicrob Chemother. 2014 Oct;69(10):2785-96</RefSource>
<PMID Version="1">24951534</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transplantation. 2001 Apr 15;71(7):910-3</RefSource>
<PMID Version="1">11349726</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transplantation. 2002 Sep 15;74(5):688-95</RefSource>
<PMID Version="1">12352887</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>J Heart Lung Transplant. 2010 Nov;29(11):1240-4</RefSource>
<PMID Version="1">20591690</PMID>
</CommentsCorrections>
<CommentsCorrections RefType="Cites"><RefSource>Transplantation. 2011 Jun 15;91(11):1254-60</RefSource>
<PMID Version="1">21617588</PMID>
</CommentsCorrections>
</CommentsCorrectionsList>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000465" MajorTopicYN="N">Algorithms</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000935" MajorTopicYN="N">Antifungal Agents</DescriptorName>
<QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005500" MajorTopicYN="N">Follow-Up Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006084" MajorTopicYN="N">Graft Rejection</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006085" MajorTopicYN="N">Graft Survival</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016867" MajorTopicYN="N">Immunocompromised Host</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008107" MajorTopicYN="N">Liver Diseases</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName>
<QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName>
<QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016031" MajorTopicYN="N">Liver Transplantation</DescriptorName>
<QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009181" MajorTopicYN="N">Mycoses</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
<QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName>
<QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011183" MajorTopicYN="N">Postoperative Complications</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D014019" MajorTopicYN="N">Tissue Donors</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D066027" MajorTopicYN="Y">Transplant Recipients</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D014481" MajorTopicYN="N" Type="Geographic">United States</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
</MeshHeadingList>
<OtherID Source="NLM">NIHMS667740</OtherID>
<OtherID Source="NLM">PMC4365781</OtherID>
<KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Antibiotic: antifungal</Keyword>
<Keyword MajorTopicYN="N">antibiotic prophylaxis</Keyword>
<Keyword MajorTopicYN="N">clinical research/practice</Keyword>
<Keyword MajorTopicYN="N">complication: infectious</Keyword>
<Keyword MajorTopicYN="N">fungal</Keyword>
<Keyword MajorTopicYN="N">infection and infectious agents</Keyword>
<Keyword MajorTopicYN="N">infectious disease</Keyword>
<Keyword MajorTopicYN="N">liver transplantation/hepatology</Keyword>
<Keyword MajorTopicYN="N">liver transplantation: living donor</Keyword>
<Keyword MajorTopicYN="N">pharmacology</Keyword>
</KeywordList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2014</Year>
<Month>05</Month>
<Day>05</Day>
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<PubMedPubDate PubStatus="revised"><Year>2014</Year>
<Month>08</Month>
<Day>08</Day>
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<PubMedPubDate PubStatus="accepted"><Year>2014</Year>
<Month>08</Month>
<Day>25</Day>
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<PubMedPubDate PubStatus="entrez"><Year>2014</Year>
<Month>11</Month>
<Day>1</Day>
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<PubMedPubDate PubStatus="medline"><Year>2015</Year>
<Month>9</Month>
<Day>26</Day>
<Hour>6</Hour>
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<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">25359455</ArticleId>
<ArticleId IdType="doi">10.1111/ajt.12993</ArticleId>
<ArticleId IdType="pmc">PMC4365781</ArticleId>
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<affiliations><list><country><li>États-Unis</li>
</country>
<region><li>Pennsylvanie</li>
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<tree><noCountry><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, C J" sort="Clancy, C J" uniqKey="Clancy C" first="C J" last="Clancy">C J Clancy</name>
<name sortKey="Clarke, L G" sort="Clarke, L G" uniqKey="Clarke L" first="L G" last="Clarke">L G Clarke</name>
<name sortKey="Humar, A" sort="Humar, A" uniqKey="Humar A" first="A" last="Humar">A. Humar</name>
<name sortKey="Kwak, E J" sort="Kwak, E J" uniqKey="Kwak E" first="E J" last="Kwak">E J Kwak</name>
<name sortKey="Nguyen, M H" sort="Nguyen, M H" uniqKey="Nguyen M" first="M H" last="Nguyen">M H Nguyen</name>
<name sortKey="Potoski, B A" sort="Potoski, B A" uniqKey="Potoski B" first="B A" last="Potoski">B A Potoski</name>
<name sortKey="Shields, R K" sort="Shields, R K" uniqKey="Shields R" first="R K" last="Shields">R K Shields</name>
<name sortKey="Silveira, F P" sort="Silveira, F P" uniqKey="Silveira F" first="F P" last="Silveira">F P Silveira</name>
<name sortKey="Vergidis, P" sort="Vergidis, P" uniqKey="Vergidis P" first="P" last="Vergidis">P. Vergidis</name>
</noCountry>
<country name="États-Unis"><region name="Pennsylvanie"><name sortKey="Eschenauer, G A" sort="Eschenauer, G A" uniqKey="Eschenauer G" first="G A" last="Eschenauer">G A Eschenauer</name>
</region>
</country>
</tree>
</affiliations>
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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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