TITLE

Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients

AUTHOR(S)
Playford, E. G.; Webster, A. C.; Sorrell, T. C.; Craig, J. C.
PUB. DATE
September 2006
SOURCE
European Journal of Clinical Microbiology & Infectious Diseases;Sep2006, Vol. 25 Issue 9, p549
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
A systematic review and meta-analysis was performed to evaluate the benefits and harms of antifungal prophylaxis in liver transplant recipients. Ten randomised trials comparing any prophylactic antifungal regimen with no antifungal agent or with another antifungal regimen were identified from Medline, EMBASE, the Cochrane Library, and other sources. Together, the studies included a total of 1,106 patients. In general, results were consistent across trials despite clinical and methodological heterogeneity. Antifungal prophylaxis did not reduce total mortality (RR 0.84, 95% CI: 0.54–1.3). Fluconazole prophylaxis reduced invasive fungal infections by about 75% (RR 0.28, 95% CI: 0.13–0.57). Although fewer data on prophylactic itraconazole and liposomal amphotericin B were available, indirect comparisons and three direct comparative trials suggested similar efficacy. Fluconazole prophylaxis did not significantly increase colonisation or infection with azole-resistant fungi, although data were limited. A subgroup analysis suggested a dose and duration effect. In conclusion, fluconazole prophylaxis significantly reduces invasive fungal infections in liver transplant recipients and should be instituted in patients at increased risk in the early postoperative period.
ACCESSION #
22285767

 

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