Purpose: This study was conducted to determine the incidence of proven or probable invasive fungal infections in the first 90 days after transplant in high risk liver transplant recipients who either did or did not receive post-operative micafungin prophylaxis.

Methods: This is a single-center, retrospective chart review of all adult liver or combined liver-kidney patients transplanted between January 1, 2013 and December 31, 2015. Subjects were included if they had at least one major risk factor for developing an invasive fungal infection in the setting of liver transplant. Risk factors included renal dysfunction warranting renal replacement therapy, large intraoperative blood loss requiring 20 or more units of blood products, re-operation or re-transplantation. The primary outcome is the incidence of invasive fungal infection within the first 90 days post-transplant, while secondary outcomes include mortality, average duration of prophylaxis, requirements for other antifungals and speciation data for positive fungal cultures.

Results: 160 patients were transplanted during the study time period, and 46 met criteria for inclusion as high risk for invasive fungal infections. Post-operatively, 24 received micafungin, and 22 did not receive micafungin. There were no significant differences in baseline characteristics including age, gender or MELD between these two groups. Of note, the majority (82%) of the non-micafungin group received fluconazole prophylaxis. The average duration of micafungin prophylaxis was 22 days.

There were no proven or probable fungal infections in the micafungin group, versus 4 infections in the non- micafungin group (p=0.03). There were 2 deaths in the micafungin group and 4 in the non-micafungin group, 2 of which were attributed to invasive aspergillus infection.

Conclusion: In this single-center study, micafungin was effective as invasive fungal infection prophylaxis in liver and liver-kidney transplant patients at high risk for these infections. Given the risk of mortality associated with these infections, including aspergillus, broad anti-fungal prophylaxis should be considered in high risk patients.

CITATION INFORMATION: Nolan A., Harriott N., Startsman K. Micafungin Prophylaxis in Liver Transplant Recipients at High Risk for Invasive Fungal Infections Am J Transplant. 2017;17 (suppl 3).

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