[Prevention of mycotic infections in liver transplant recipients: comparison of two chemoprophylactic protocols]

ACKGROUND: The aim of the study was to compare and evaluate the efficacy of two chemoprophylactic protocols against mycotic infections in a liver transplant recipients population. DESIGN: single-blind, randomized. SETTING: Liver transplant Center of a National Health System teaching hospital. METHODS: Eighty-eight consecutive patients submitted to liver transplantation were enrolled in the study. Immediately before surgery they were randomized to receive sequential treatment with intravenous liposomal amphotericine B + oral itraconazole or intravenous fluconazole + oral itraconazole. Intravenous drugs were administered in the first postoperative week, and oral treatments for the following three weeks. In addition to analyzing the frequency and incidence of colonization, local and disseminated infection of mycotic origin, the causes of death and the possible risk factors for mycotic disease have been examined. RESULTS: Eighty-five patients completed the study. No significative difference was evident in the two groups as regards to single organ and systemic fungal infection rate. Two out of a total of 5 deaths were related to mycotic disease. Pre-transplant fungal colonization, more severe liver disease indicating the transplant procedure and the rejection of the graft were all risk factors for the development of mycotic infection. CONCLUSIONS: The two protocols used in the study showed and equal efficacy in preventing fungal infections in liver transplant recipients.