Cruciani M et al. (2006) Antifungal prophylaxis in liver transplant patients: a systematic review and meta-analysis. Liver Transpl 12: 850–858

Fungal infections following liver transplantation have been associated with extremely high mortality rates, so a group of Italian researchers conducted a meta-analysis of six randomized clinical trials (with a total of 698 patients), in order to assess the efficacy of antifungal prophylaxis before liver transplantation.

They found that fungal infections were significantly less frequent in patients who received prophylactic treatment than in control patients (relative risk reduction 69.2%). The risk of mortality due to fungal infection was also lower in patients who received prophylactic treatment (relative risk reduction 71.6%). Overall mortality rates and the need for empiric treatment of fungal infection were unaffected. Side effects were more common in patients who received prophylactic treatment, but rates of treatment discontinuation did not differ between the two groups.

The beneficial effect of antifungal prophylaxis was found to be mainly the result of a reduction in the incidence of Candida albicans infection and C. albicans-attributable mortality. It is notable, however, that patients who received prophylactic treatment experienced a higher proportion of non-albicans Candida infections (mainly C. glabrata) than did control patients. The authors recommend that this increased incidence of triazole-resistant Candida strains should be addressed in future studies.