Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach

Yi Chan Chen, Ting Shuo Huang, Yu Chao Wang, Chih Hsien Cheng, Chen Fang Lee, Ting Jun Wu, Hong Shiue Chou, Kun Ming Chan, Wei Chen Lee, Ruey Shyang Soong

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors. Results. The cumulative hazards and transition probability of "transplantation to fungal infection" were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% (p = 0.052); overall mortality improved from 40.8% to 23.4% (p < 0.001). In the "transplantation to fungal infection" transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34-0.96, p = 0.033). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality. Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections.

Original languageEnglish
Article number6212503
JournalBioMed Research International
Volume2016
DOIs
Publication statusPublished - 2016
Externally publishedYes

ASJC Scopus subject areas

  • General Immunology and Microbiology
  • General Biochemistry,Genetics and Molecular Biology

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