Candida colonization in orthotopic liver transplantation: Fluconazole versus oral amphotericin B

A. M. Tortorano, M. A. Viviani, A. Pagano, G. Paone, B. Gridelli, G. Breda, M. Langer

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Abstract

Liver transplant recipients are at high risk for invasive candidosis due to the elevated rate of Candida colonization. With the aim of identifying an effective prophylaxis, a randomized 3-year study was conducted on 75 liver transplanted patients in the Liver Transplantation Department of the University of Milan to compare the efficacy of intravenous/oral fluconazole (200 mg/day) versus oral amphotericin B (6,000 mg/day). Patients were randomized to one of the two antifungal prophylaxis protocols during the transplant operation. Mycological surveillance was performed on alternate days during the 4 weeks of prophylaxis. At the time of transplant Candida colonization was detected in 21/34 evaluable patients allocated to amphotericin B and 20/38 allocated to fluconazole. Candida albicans was the most frequently isolated species (detected in 17 and 11 patients in the amphotericin B and fluconazole groups, respectively). Amphotericin B cleared 12/21 colonizations, including 8 caused by C. albicans, and prevented Candida colonization in 11/13 patients. Fluconazole cured the 11 patients colonized by C. albicans but was ineffective against C. glabrata and C. krusei colonization in 9 cases. Colonization was prevented by the triazole in all 18 patients whose mucous membranes were not colonized at the time of transplant. Both antifungals were safe and well tolerated and no interaction with cyclosporin A was evident during fluconazole treatment. Fluconazole seems the antifungal of choice for prophylaxis in liver transplant recipients as it proved more effective than oral amphotericin B against C. albicans, which was involved in 70% of colonizations in our series. The disadvantage of its ineffectiveness against C. glabrata and C. krusei may be overcome by mycological surveillance enabling a prompt change of antifungal in presence of colonization by these species. In addition, administration of the triazole (once daily, intravenously/orally) is more convenient than that of amphotericin B (every 6 hours, per os and by nasogastric tube, if present).

Original languageEnglish
Pages (from-to)21-24
Number of pages4
JournalJournal de Mycologie Medicale
Volume5
Issue number1
Publication statusPublished - 1995

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Keywords

  • Candida colonization
  • fluconazole
  • liver transplantation
  • oral amphotericin B

ASJC Scopus subject areas

  • Agricultural and Biological Sciences (miscellaneous)
  • Microbiology

Cite this

Tortorano, A. M., Viviani, M. A., Pagano, A., Paone, G., Gridelli, B., Breda, G., & Langer, M. (1995). Candida colonization in orthotopic liver transplantation: Fluconazole versus oral amphotericin B. Journal de Mycologie Medicale, 5(1), 21-24.