Antifungal Management Practices in Liver Transplant Recipients

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To cite this article: N. Singh, M. M. Wagener, T. V. Cacciarelli, J. Levitsky (2008) Antifungal Management Practices in Liver Transplant Recipients American Journal of Transplantation 8 (2), 426–431. doi:10.1111/j.1600-6143.2007.02089.x

Abstract

Antifungal Management Practices in Liver Transplant Recipients

N. Singha,*aVA Medical Center and University of Pittsburgh, Pittsburgh, PA*Corresponding author: Nina Singh, nis5@..., M. M. WageneraaVA Medical Center and University of Pittsburgh, Pittsburgh, PA, T. V. CacciarelliaaVA Medical Center and University of Pittsburgh, Pittsburgh, PA and J. LevitskybbNorthwestern University, Chicago, IL

aVA Medical Center and University of Pittsburgh, Pittsburgh, PA bNorthwestern University, Chicago, IL

*Corresponding author: Nina Singh, nis5@...

Data presented in part at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, September 17–20, 2007.

Abstract

We sought to determine the approach to antifungal prophylaxis, and diagnostic and therapeutic practices for the management of invasive aspergillosis in liver transplant recipients. Data were collected by an electronic survey questionnaire sent to all active liver transplant programs in North America; 63% (67/106) of the sites completed the survey. Overall, 91% of the sites employed antifungal prophylaxis; 28% used universal prophylaxis and 72% targeted it toward high-risk patients. Fluconazole was the most commonly used agent for universal and targeted prophylaxis. The leading choice for mold-active agents for antifungal prophylaxis was the echinocandins. Combination therapy was used as primary therapy for invasive aspergillosis in 47%, and as salvage in 80%. Thus, a vast majority of the surveyed programs employ antifungal prophylaxis and most use targeted prophylaxis. Consideration of these practices could guide clinical trial design to optimize antifungal prophylaxis in these patients. Our findings also merit investigations to better define the role of diagnostic assays and combination therapeutic strategies for invasive aspergillosis in liver transplant recipients.