Caspofungin vs fluconazole as prophylaxis of invasive fungal infection in high-risk liver transplant recipients: A propensity score analysis.
Liver Transpl. 2015 Dec 28;
Authors: Fortún J, Muriel A, Martín-Dávila P, Montejo M, Len O, Torre-Cisneros J, Carratalá J, Muñoz P, Fariñas C, Moreno A, Fresco G, Goikoetxea J, Gavaldá J, Pozo JC, Bodro M, Vena A, Casafont F, Cervera C, Silva JT, Aguado JM, GESITRA/GEMICOMED (SEIMC), and REIPI (a).
BACKGROUND: Targeted prophylaxis has proven to be an efficient strategy in liver transplant recipients (LTR).
OBJECTIVE: To compare the effectiveness and safety of caspofungin with that of fluconazole in high-risk LTR (HR-LTR).
METHODS: Caspofungin and fluconazole were compared in a multicenter, retrospective, cohort study in HR-LTR in Spain. Outcomes were assessed at 180 days after transplantation. A propensity score approach was applied.
RESULTS: During the study period (2005-2012), we analyzed 195 HR-LTR from 9 hospitals. By type of prophylaxis, 97 patients received caspofungin and 98 received fluconazole Of a total of 17 global IFI (8.7%), breakthrough IFI accounted for 11 (5.6%) and invasive aspergillosis (IA) for 6 (3.1%). By univariate analysis, no differences were observed in the prevention of global IFI. However, caspofungin was associated with a significant reduction in the rate of breakthrough IFI (2.1% vs 9.2%, p: 0.04). In patients requiring dialysis (n: 62), caspofungin significantly reduced the frequency of breakthrough IFI (p: 0.03). The propensity score analysis confirmed a significant reduction in the frequency of IA in patients receiving caspofungin (absolute risk reduction: 0.06; 95%CI: 0.001-0.11; p: 0.044). Linear regression analysis revealed a significant decrease in blood alanine aminotransferase levels and a significant increase in bilirubin levels after administration of caspofungin.
CONCLUSIONS: Caspofungin and fluconazole have similar efficacy for the prevention of global IFI in HR-LTR in this observational, multicenter cohort study. However, caspofungin was associated with a significant reduction of breakthrough IFI and, after adjusting for confounders, caspofungin was associated with a lower rate of IA. This benefit is probably more favorable in patients on dialysis. Caspofungin is safe in HR-LTR, although bilirubin levels may be increased. This article is protected by copyright. All rights reserved.
PMID: 26709146 [PubMed - as supplied by publisher]