In:
Clinical Transplantation, Wiley, Vol. 27, No. 4 ( 2013-07)
Abstract:
Antifungal prophylaxis is recommended in high‐risk patients, but risk criteria remain unclear and the predictive value of Model of End‐Stage Liver Disease ( MELD ) score is unknown. In a retrospective, single‐center analysis of 667 liver transplants, potential risk factors for fungal infection were assessed, including MELD score. Antifungal prophylaxis was administered in 198 patients (29.4%). During follow‐up (mean 43.6 ± 29.6 months), 263 patients (39.4%) developed ≥1 episode of fungal infection, and 187 (28.0%) patients developed a probable or proven invasive fungal infection requiring systemic antifungal treatment. Patients receiving antifungal prophylaxis had a lower incidence of fungal infection (29.8% vs. 43.5% without prophylaxis, p 〈 0.001) and invasive fungal infection (17.7% vs. 32.4%, p 〈 0.001). One‐yr patient survival was 91%, 85% and 69%, respectively, in patients with no fungal infection, fungal colonization and treated invasive fungal infection (p 〈 0.001); graft survival was 88%, 85% and 66% (p 〈 0.001). Multivariate analysis indicated that MELD score of 20–30 or ≥30 was associated with a 2.0‐fold or 4.3‐fold increase in relative risk of fungal infection, respectively, and a 2.1‐fold or 3.1‐fold increase in relative risk of invasive fungal infection. In conclusion, liver transplant patients with a MELD score ≥20, and particularly patients with a score ≥30, are candidates for antifungal prophylaxis.
Type of Medium:
Online Resource
ISSN:
0902-0063
,
1399-0012
DOI:
10.1111/ctr.2013.27.issue-4
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2739458-X
detail.hit.zdb_id:
2004801-4
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