Randomized Trial of Micafungin for the Prevention of Invasive Fungal Infection in High-Risk Liver Transplant Recipients

Saliba, Faouzi; Pascher, Andreas; Cointault, Olivier; Laterre, Pierre‐François; Cervera, Carlos; Waele, Jan J. De; Cillo, Umberto; Langer, Róbert; Lugano, Manuela; Göran-Ericzon, Bo; Phillips, Stephen J.; Tweddle, Lorraine; Karas, Andreas; Brown, Mark; Fischer, Lutz; Pratschke, Johann; Decruyenaere, Johan; Moreno, Christophe; Michielsen, P.; Neuhaus, P.; Schemmer, Peter; Varó, Evaristo; Montejo, Miguel; Bouza, Emilio; Blanes, Marino; Torre, Julián de la; Fortün, Jesús; Rostaing, Lionel; Paugam–Burtz, Catherine; Eyraud, Daniel; Shah, Tahir; Heaton, Nigel; McCormick, Aiden; Salizzoni, Mauro; Gasperi, Andrea De; Tomé, Luís; Daniel, J.; Popescu, Irinel; Moysyuk, Ya. G.; Chzhao, Alexey V.; Zagaynov, V. E.; Ericzon, Bo‐Göran

doi:10.1093/cid/ciu1128

Cited by 69 publications

(59 citation statements)

References 40 publications

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“…Our result was similar to the incidence reported elsewhere, with rates reaching 17.7% [1,4,15,16,17,18,19,20,21]. In the era of MELD and targeted prophylactic antifungal therapy, our study was able to offer three interesting pieces of information: (i) all patients who developed IFI within two months of LT had one or more risk factors and were receiving antifungal therapy after LT; (ii) the time to onset of IFI in the ICU after LT ranged from five days to 252 days.…”

Section: Discussionsupporting

confidence: 92%

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Levesque

Rizk

Noorah

et al. 2017

IJMS

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Invasive fungal infections (IFI) are complications after liver transplantation involving high morbidity and mortality. (1,3)-β-d-glucan (BG) is a biomarker for IFI, but its utility remains uncertain. This study was designed to evaluate the impact of BG following their diagnosis. Between January 2013 and May 2016, 271 liver transplants were performed in our institution. Serum samples were tested for BG (Fungitell®, Associates Cape Code Inc., Falmouth, MA, USA) at least weekly between liver transplantation and the discharge of patients. Nineteen patients (7%) were diagnosed with IFI, including 13 cases of invasive candidiasis (IC), eight cases of invasive pulmonary aspergillosis, and one case of septic arthritis due to Scedosporium apiospernum. Using a single BG sample for the primary analysis of IFI, 95% (21/22) of the subjects had positive BG (>80 pg/mL) at the time of IFI diagnosis. The area under the ROC curves to predict IFI was 0.78 (95% CI: 0.73–0.83). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BG for IFI were 75% (95% CI: 65–83), 65% (62–68), 17% (13–21), and 96% (94–97), respectively. Based on their high NPV, the BG test appears to constitute a good biomarker to rule out a diagnosis of IFI.

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Section: Discussionsupporting

confidence: 92%

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Levesque

Rizk

Noorah

et al. 2017

IJMS

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“…Fort un et al demonstrated that the prophylactic use of caspofungin for 21 days in liver transplant recipients at high risk for IFD not only was well tolerated but also notably reduced the incidence of this complication (27). More recently, the TENPIN study also reported the noninferiority of micafungin compared with the standard of care in high-risk liver transplant patients, with a more favorable renal safety profile (28). In contrast, most cases of IFD in pediatric patients occurred beyond month 6, once antimold prophylaxis had been stopped (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Infectious Complications Following Small Bowel Transplantation

Silva

Juan

Fernández-Caamaño

et al. 2016

American Journal of Transplantation

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Microbiological spectrum and outcome of infectious complications following small bowel transplantation (SBT) have not been thoroughly characterized. We performed a retrospective analysis of all patients undergoing SBT from 2004 to 2013 in Spain. Sixty-nine patients underwent a total of 87 SBT procedures (65 pediatric, 22 adult). The median follow-up was 867 days. Overall, 81 transplant patients (93.1%) developed 263 episodes of infection (incidence rate: 2.81 episodes per 1000 transplant-days), with no significant differences between adult and pediatric populations. Most infections were bacterial (47.5%). Despite universal prophylaxis, 22 transplant patients (25.3%) developed cytomegalovirus disease, mainly in the form of enteritis. Specifically, 54 episodes of opportunistic infection (OI) occurred in 35 transplant patients. Infection was the major cause of mortality (17 of

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“…Despite this high infectious complication rate, there is a paucity of data regarding antibiotic prophylaxis in OLT patients. Several trials have evaluated perioperative antifungal and antiviral prophylaxis . Another trial has assessed the type of antimicrobial prophylaxis; however, there have been no studies comparing surgical prophylaxis duration and rates of postoperative infections in liver transplant patients, highlighting the dearth of evidence surrounding perioperative antibiotic prophylaxis in these patients .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

Berry

Rosenberger²,

Guidry

et al. 2019

Liver Transpl

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The appropriate duration of surgical antibiotic prophylaxis in orthotopic liver transplantation (OLT) in the presence of significant iatrogenic immunosuppression is unclear. We hypothesized that 72 hours of perioperative antibiotic prophylaxis would decrease rates of surgical site infection (SSI) in OLT patients when compared with intraoperative antibiotic prophylaxis alone. OLT recipients were randomized to receive either intraoperative antibiotics only (short antibiotics [SAs]) or 72 hours of perioperative antibiotics (extended antibiotics [EAs]). A total of 102 patients were randomized: 51 to the EA group and 51 to the SA group. Rates of SSI and nosocomial infection (NI) in the SA group were 19% and 17%, respectively, compared with 27% (SSI; P = 0.36) and 22% (NI; P = 0.47) in the EA group, although these differences were not statistically significant. Intensive care unit (ICU) length of stay (LOS), hospital LOS, 30‐day mortality, and time to infection were also similar between the 2 groups. Patients developing infections had longer ICU LOS and hospital LOS and a higher association with reoperation, endoscopic retrograde cholangiopancreatography, and 30‐day readmission. In conclusion, extending perioperative antibiotics to 72 hours from intraoperative dosing alone in OLT patients does not appear to decrease the incidence of SSI or NI. The results from this pilot trial with 60% power suggest that it is acceptable for OLT recipients to receive intraoperative antibiotic prophylaxis alone.

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Randomized Trial of Micafungin for the Prevention of Invasive Fungal Infection in High-Risk Liver Transplant Recipients

Abstract: In this randomized clinical trial comparing micafungin 100 mg with standard-care antifungal prophylaxis (fluconazole, liposomal amphotericin B, or caspofungin) in high-risk liver transplant patients, micafungin 100 mg was noninferior and had a better kidney safety profile.

Cited by 69 publications

References 40 publications

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients

Infectious Complications Following Small Bowel Transplantation

Intraoperative Versus Extended Antibiotic Prophylaxis in Liver Transplant Surgery: A Randomized Controlled Pilot Trial

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