Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO, USA.
HPB (Oxford). 2013 Jul;15(7):541-7. doi: 10.1111/hpb.12006. Epub 2012 Nov 22.
Invasive fungal infections (IFI) remain a significant cause of morbidity and mortality in orthotopic liver transplantation (OLT) recipients. In this retrospective study, the outcomes of a protocol using once weekly fluconazole for 3 months after OLT in low- and high-risk patients were reviewed.
In total, 221 OLTs were evaluated in the 3-year period after institution of the new protocol to determine the incidence of IFI within 6 months post-OLT.
In this cohort, 11 IFIs developed during the 6-month post-transplant period, with the majority being non-albicans Candida. High-risk patients had a greater rate of IFI (16.7% versus 3.4%, P = 0.038) and a significantly longer intensive unit care (ICU) and hospital lengths of stay compared with low-risk patients. Patient and graft survival were similar between the groups. Our patient population appeared to be at low risk for IFI, with 92% of the entire cohort considered low risk.
Given the low incidence of IFI in the low-risk group and the possibility of such protocol selecting out for fluconazole-resistant fungi, the use of weekly fluconazole for 3 months may not be justifiable in low-risk OLT recipients. Given the increased resource utilization observed with IFI, further examination of a more intensive prophylactic strategy in high-risk patients may be warranted.
侵袭性真菌感染（IFI）仍然是原位肝移植（OLT）受者发病率和死亡率的重要原因。在这项回顾性研究中，回顾了在 OLT 后使用每周一次氟康唑进行 3 个月的方案在低危和高危患者中的结果。
在新方案实施后的 3 年内，共评估了 221 例 OLT，以确定 OLT 后 6 个月内 IFI 的发生率。
在该队列中，有 11 例在移植后 6 个月内发生 IFI，其中大多数是非白色念珠菌属念珠菌。高危患者的 IFI 发生率更高（16.7%比 3.4%，P=0.038），与低危患者相比，重症监护病房（ICU）和住院时间明显延长。两组患者和移植物存活率相似。我们的患者人群似乎 IFI 风险较低，整个队列中有 92%的患者被认为是低危。
鉴于低危组 IFI 的发生率较低，并且该方案有可能选择出氟康唑耐药真菌，因此每周氟康唑使用 3 个月可能不适用于低危 OLT 受者。鉴于观察到IFI 导致资源利用增加，可能需要进一步检查高危患者更密集的预防策略。
