Antifungal Prophylaxis in Liver Transplantation: A Systematic Review and Network Meta‐Analysis
Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis...
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Published in | American journal of transplantation Vol. 14; no. 12; pp. 2765 - 2776 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
Hoboken, NJ
Wiley
01.12.2014
Wiley Subscription Services, Inc |
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Abstract | Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random‐effects meta‐analysis and a Bayesian network meta‐analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L‐AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19–0.72, p = 0.003), suspected or proven IFI (OR 0.40, CI 0.25–0.66, p = 0.0003) and mortality due to IFI (OR 0.32, CI 0.10–0.83, p = 0.02) when compared to placebo. All‐cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48–2.55, p = 0.81). In the network meta‐analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06–0.57) and L‐AmB (OR 0.21, CI 0.05–0.71) compared with placebo. Routine prophylaxis with fluconazole or L‐AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy.
This systematic review and network meta‐analysis demonstrates that fluconazole and liposomal amphotericin B are equally effective agents for antifungal prophylaxis in liver transplant recipients, and both are superior to itraconazole or no prophylaxis. |
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AbstractList | Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random‐effects meta‐analysis and a Bayesian network meta‐analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L‐AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19–0.72, p = 0.003), suspected or proven IFI (OR 0.40, CI 0.25–0.66, p = 0.0003) and mortality due to IFI (OR 0.32, CI 0.10–0.83, p = 0.02) when compared to placebo. All‐cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48–2.55, p = 0.81). In the network meta‐analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06–0.57) and L‐AmB (OR 0.21, CI 0.05–0.71) compared with placebo. Routine prophylaxis with fluconazole or L‐AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy.
This systematic review and network meta‐analysis demonstrates that fluconazole and liposomal amphotericin B are equally effective agents for antifungal prophylaxis in liver transplant recipients, and both are superior to itraconazole or no prophylaxis. Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random-effects meta-analysis and a Bayesian network meta-analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L-AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19-0.72, p = 0.003), suspected or proven IFI (OR 0.40, CI 0.25-0.66, p = 0.0003) and mortality due to IFI (OR 0.32, CI 0.10-0.83, p = 0.02) when compared to placebo. All-cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48-2.55, p = 0.81). In the network meta-analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06-0.57) and L-AmB (OR 0.21, CI 0.05-0.71) compared with placebo. Routine prophylaxis with fluconazole or L-AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy. Invasive fungal infections (IFIs) cause significant morbidity and mortality in liver transplant recipients, but the need and best agent for prophylaxis is uncertain. A comprehensive literature search was performed to identify randomized controlled trials comparing regimens for antifungal prophylaxis in liver transplant recipients. Direct comparisons were made between treatments using random-effects meta-analysis and a Bayesian network meta-analysis was performed for the primary end point of proven IFI. Fourteen studies met inclusion criteria, reporting comparisons of fluconazole, liposomal amphotericin B (L-AmB), itraconazole, micafungin and placebo. Overall, antifungal prophylaxis reduced the rate of proven IFI (odds ratio [OR] 0.37, confidence interval [CI] 0.19-0.72, p=0.003), suspected or proven IFI (OR 0.40, CI 0.25-0.66, p=0.0003) and mortality due to IFI (OR 0.32, CI 0.10-0.83, p=0.02) when compared to placebo. All-cause mortality was not significantly affected. There was no difference in risk of adverse events requiring cessation of prophylaxis (OR 1.11, 95% CI 0.48-2.55, p=0.81). In the network meta-analysis an equivalent reduction in the rate of IFI was seen with fluconazole (OR 0.21, CI 0.06-0.57) and L-AmB (OR 0.21, CI 0.05-0.71) compared with placebo. Routine prophylaxis with fluconazole or L-AmB reduces the incidence of IFI following liver transplantation, and the available evidence suggests that the two are equivalent in efficacy. This systematic review and network meta-analysis demonstrates that fluconazole and liposomal amphotericin B are equally effective agents for antifungal prophylaxis in liver transplant recipients, and both are superior to itraconazole or no prophylaxis. |
Author | Morris, P. J. Evans, J. D. W. Knight, S. R. |
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Keywords | Chemoprophylaxis Treatment Digestive system Surgery Liver Network Graft Systematic review Homotransplantation Metaanalysis Liver transplantation fungal hepatology infectious disease, liver transplantation meta-analysis Clinical research antibiotic: antifungal infection and infectious agents practice, health services and outcomes research complication: infectious |
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SubjectTerms | Antibiotic Prophylaxis antibiotic: antifungal Antifungal Agents - therapeutic use Biological and medical sciences Clinical research complication: infectious fungal Graft Rejection - etiology Graft Rejection - prevention & control Health risk assessment hepatology Humans infection and infectious agents infectious disease, liver transplantation Liver Liver Diseases - surgery Liver Transplantation - adverse effects Liver, biliary tract, pancreas, portal circulation, spleen Medical sciences Meta-analysis Mortality Mycoses - microbiology Mycoses - prevention & control Postoperative Complications practice, health services and outcomes research Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system Transplants & implants |
Title | Antifungal Prophylaxis in Liver Transplantation: A Systematic Review and Network Meta‐Analysis |
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