EPICO 3.0. Antifungal prophylaxis in solid organ transplant recipients

• Published in: Revista iberoamericana de micología 2016-10, Vol.33 (4), p.187-195
• Main Authors: Zaragoza, Rafael, Aguado, José María, Ferrer, Ricard, Rodríguez, Alejandro H, Maseda, Emilio, Llinares, Pedro, Grau, Santiago, Muñoz, Patricia, Fortún, Jesús, Bouzada, Mercedes, Pozo, Juan Carlos del, León, Rafael
• Format: Article
• Language: English
• Subjects: Anfotericina B liposómica; Echinocandin; Equinocandina; Fluconazol; Fluconazole; Infectious Disease; Liposomal amphotericin B; Profilaxis; Prophylaxis; Solid organ transplant; Trasplante de órgano sólido; Voriconazol; Voriconazole
• ISSN: 1130-1406
• DOI: 10.1016/j.riam.2016.02.001

Abstract Background Although over the past decade the management of invasive fungal infection has improved, considerable controversy persists regarding antifungal prophylaxis in solid organ transplant recipients. Aims To identify the key clinical knowledge and make by consensus the high level recommendations required for antifungal prophylaxis in solid organ transplant recipients. Methods Spanish prospective questionnaire, which measures consensus through the Delphi technique, was conducted anonymously and by e-mail with 30 national multidisciplinary experts, specialists in invasive fungal infections from six national scientific societies, including intensivists, anesthetists, microbiologists, pharmacologists and specialists in infectious diseases that responded to 12 questions prepared by the coordination group, after an exhaustive review of the literature in the last few years. The level of agreement achieved among experts in each of the categories should be equal to or greater than 70% in order to make a clinical recommendation. In a second term, after extracting the recommendations of the selected topics, a face-to-face meeting was held with more than 60 specialists who were asked to validate the pre-selected recommendations and derived algorithm. Measurements and primary outcomes Echinocandin antifungal prophylaxis should be considered in liver transplant with major risk factors (retransplantation, renal failure requiring dialysis after transplantation, pretransplant liver failure, not early reoperation, or MELD > 30); heart transplant with hemodialysis, and surgical re-exploration after transplantation; environmental colonization by Aspergillus , or cytomegalovirus (CMV) infection; and pancreas and intestinal transplant in case of acute graft rejection, hemodialysis, initial graft dysfunction, post-perfusion pancreatitis with anastomotic problems or need for laparotomy after transplantation. Antifungal fluconazole prophylaxis should be considered in liver transplant without major risk factors and MELD 20–30, split or living donor, choledochojejunostomy, increased transfusion requirements, renal failure without replacement therapy, early reoperation, or multifocal colonization or infection with Candida ; intestinal and pancreas transplant with no risk factors for echinocandin treatment. Liposomal amphotericin B antifungal prophylaxis should be considered in lung transplant (inhalant form) and liver transplant with major risk factors. Antifungal prophy