Effect of prophylaxis on fungal infection and costs for high-risk liver transplant recipients

✍ Scribed by Alan Reed; Jill Boylston Herndon; Nail Ersoz; Takahisa Fujikawa; Denise Schain; Paul Lipori; Alan Hemming; Qin Li; Elizabeth Shenkman; Bruce Vogel

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 146 KB
• Volume: 13
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21331

✦ Synopsis

We sought to determine whether the prophylactic use of amphotericin B products (conventional amphotericin B and liposomal amphotericin B) reduces the incidence of fungal infections in high-risk liver transplant recipients, and if so, whether this lowers the cost of care. The study sample comprised 232 adult orthotopic liver transplants performed from 1994 to 2005 at a single center for patients classified as being at high risk for fungal infections. High-risk patients who received transplants with a prophylaxis regimen of amphotericin B (n ϭ 58 transplants) were compared with high-risk patients who received no prophylaxis (n ϭ 174 transplants). Fungal infections occurred in 3 transplants (5.17%) of those who received amphotericin B and 28 transplants (16.09%) in those without prophylaxis (P ϭ 0.0432). Regression models were used to analyze fungal infection and costs for the 232 high-risk transplants. Failure to offer prophylaxis conferred a 4-fold greater risk of fungal infection (P ϭ 0.046) compared with those who received amphotericin B. A fungal infection in a high-risk recipient increased mean costs by 46.48%. The indirect effect of prophylaxis (operating through infection reduction) is estimated to reduce overall costs in high-risk patients by 8.73%.