Efficacy of Low Dose Chemoprophylaxis for Coccidioidomycosis Infection in Liver Transplantation Recipients
1Liver Research Institute, Divisions of Gastroenterology, Hepatology and Transplantation, Department of Medicine, University of Arizona, Tucson, AZ
2Division of Infectious Disease, Department of Medicine, University of Arizona, Tucson, AZ
3Internal Medicine Residency Program, Department of Medicine, University of Arizona, Tucson, AZ
4Division of Infectious Disease, Department of Medicine, University of Massachusetts, Worcester, MA
5Division of Transplantation, School of Pharmacy, University of Arizona, Tucson, AZ
6Office of Border Health, Arizona Department of Health Services, Tucson, AZ
7Division of Transplantation, Department of Surgery, University of Arizona, Tucson, AZ.
Meeting: 2015 American Transplant Congress
Abstract number: 175
Keywords: Efficacy, Fungal infection, Liver transplantation, Prophylaxis
Session Information
Session Name: Concurrent Session: ID - Epidemiology, Resistance, Geographic Infections
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 3:03pm-3:15pm
Location: Room 115-C
Introduction:Coccidioidomycosis(CM) infection rate of 6.9% has been reported in solid organ transplantation recipients living in endemic Southwestern U.S.
Aim:Assess the risk of CM infection in liver transplantation recipients receiving prophylaxis with fluconazole.
Methods:We retrospectively analyzed the University of Arizona transplant database. All liver transplantation recipients with known CM infection status were included. Patients were categorized into a)low dose(<200 mg daily) or b)standard dose (adults:200 mg/day, pediatrics:6mg/kg/day). Prophylaxis duration was broken into a)6, b)12, and c)>12 months.
Results:All liver transplant patients between 1998-2012 were reviewed and 89 were included. Patients were distributed into low 77(86.5%) and standard dose 12 (13.5%). Patient survival at 3 years did not differ statistically between the two groups (77% vs. 89%, P=0.2). Patient survival was comparable among patients receiving 6, 12 or >12 months of chemoprophylaxis. CM infection rate post-transplantation was 6.6% with low dose and 8.3% with standard dose chemoprophylaxis (p=NS). In patients with history of prior infection (n=8) reactivation rates were higher 25% vs. 5.6% in those without. Only 12.5%(1/8) had received standard dose chemoprophylaxis. There was no correlation between duration of chemoprophylaxis and infection rate post-transplantation.
Conclusion:Low dose chemoprophylaxis in liver transplantation recipients without previous CM exposure appears adequate, while standard dose chemoprophylaxis seems best in previously exposed patients. Prophylaxis for 6 months appears sufficient.
To cite this abstract in AMA style:
Ramahi REl, Habib S, Rosen S, Farran S, Walker C, Shubeilat J, Yost S, McCotter O, Cassal M, Rana A, Boyer T, Zangeneh T. Efficacy of Low Dose Chemoprophylaxis for Coccidioidomycosis Infection in Liver Transplantation Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/efficacy-of-low-dose-chemoprophylaxis-for-coccidioidomycosis-infection-in-liver-transplantation-recipients/. Accessed June 22, 2025.« Back to 2015 American Transplant Congress