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

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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.

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Acknowledgements

The authors gratefully acknowledge the assistance provided by Narelle Willis, Cochrane Renal Group coordinator, and by study authors who responded to our enquiries for additional information. The helpful suggestions of the anonymous reviewers are also gratefully acknowledged. This review is an updated version of that published in the Cochrane Library (Issue 3, 2004), which will be periodically updated.

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Authors and Affiliations

  1. Infection Management Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia

    E. G. Playford

  2. Department of Medicine, University of Sydney, Sydney, NSW 2006, Australia

    E. G. Playford & T. C. Sorrell

  3. Centre for Infectious Diseases and Microbiology, University of Sydney (Western Clinical School), Westmead, NSW 2145, Australia

    E. G. Playford & T. C. Sorrell

  4. School of Public Health, University of Sydney, Sydney, NSW 2006, Australia

    A. C. Webster & J. C. Craig

  5. Cochrane Renal Group, Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW 2145, Australia

    A. C. Webster & J. C. Craig

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  1. E. G. Playford
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  2. A. C. Webster
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  3. T. C. Sorrell
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  4. J. C. Craig
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Correspondence to E. G. Playford.

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Potential conflicts of interest: E.G.P. is a member of the Mycology Interest Group of the Australasian Society for Infectious Diseases, which is sponsored by Gilead, Pfizer, and Merck. T.C.S. has advisory board involvement with Pfizer, Merck, and Gilead, has received unrelated project funding from Pfizer, Merck, and Gilead, and is a member of the Mycology Interest Group of the Australasian Society for Infectious Diseases, which is sponsored by Gilead, Pfizer, and Merck.

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Playford, E.G., Webster, A.C., Sorrell, T.C. et al. Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients. Eur J Clin Microbiol Infect Dis 25, 549–561 (2006). https://doi.org/10.1007/s10096-006-0182-3

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