Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients

Playford, E. G., Webster, A. C., Sorrell, T. C. and Craig, J. C. (2006) Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients. European Journal of Clinical Microbiology & Infectious Diseases, 25 9: 549-561. doi:10.1007/s10096-006-0182-3


Author Playford, E. G.
Webster, A. C.
Sorrell, T. C.
Craig, J. C.
Title Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients
Journal name European Journal of Clinical Microbiology & Infectious Diseases   Check publisher's open access policy
ISSN 0934-9723
Publication date 2006-09
Sub-type Article (original research)
DOI 10.1007/s10096-006-0182-3
Volume 25
Issue 9
Start page 549
End page 561
Total pages 13
Place of publication Munich, Germany
Publisher Springer
Language eng
Subject 11 Medical and Health Sciences
1103 Clinical Sciences
Abstract A systematic review and meta-analysis was performed to evaluate the benefits and harms of antifungal prophylaxis in liver transplant recipients. Ten randomised trials comparing any prophylactic antifungal regimen with no antifungal agent or with another antifungal regimen were identified from Medline, EMBASE, the Cochrane Library, and other sources. Together, the studies included a total of 1,106 patients. In general, results were consistent across trials despite clinical and methodological heterogeneity. Antifungal prophylaxis did not reduce total mortality (RR 0.84, 95% CI: 0.54–1.3). Fluconazole prophylaxis reduced invasive fungal infections by about 75% (RR 0.28, 95% CI: 0.13–0.57). Although fewer data on prophylactic itraconazole and liposomal amphotericin B were available, indirect comparisons and three direct comparative trials suggested similar efficacy. Fluconazole prophylaxis did not significantly increase colonisation or infection with azole-resistant fungi, although data were limited. A subgroup analysis suggested a dose and duration effect. In conclusion, fluconazole prophylaxis significantly reduces invasive fungal infections in liver transplant recipients and should be instituted in patients at increased risk in the early postoperative period.
Keyword Meta-analysis
Antifungal
Liver transplant
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Thu, 07 Jan 2010, 14:37:26 EST by Ms May Balasaize on behalf of Faculty Of Health Sciences