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Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach
Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods....
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| Published in: | BioMed research international 2016-01, Vol.2016 (2016), p.1-7 |
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| creator | Soong, Ruey-Shyang Lee, Wei-Chen Chou, Hong-Shiue Wu, Ting-Jung Lee, Chen-Fang Cheng, Chih-Hsien Wang, Yu-Chao Huang, Ting-Shuo Chen, Yi-Chan Chan, Kun-Ming |
| description | Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors. Results. The cumulative hazards and transition probability of “transplantation to fungal infection” were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% ( p = 0.052 ); overall mortality improved from 40.8% to 23.4% ( p < 0.001 ). In the “transplantation to fungal infection” transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34–0.96, p = 0.033 ). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality. Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections. |
| doi_str_mv | 10.1155/2016/6212503 |
| format | article |
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Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors. Results. The cumulative hazards and transition probability of “transplantation to fungal infection” were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% ( p = 0.052 ); overall mortality improved from 40.8% to 23.4% ( p < 0.001 ). In the “transplantation to fungal infection” transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34–0.96, p = 0.033 ). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality. Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections.</description><identifier>ISSN: 2314-6133</identifier><identifier>EISSN: 2314-6141</identifier><identifier>DOI: 10.1155/2016/6212503</identifier><identifier>PMID: 27747235</identifier><language>eng</language><publisher>Cairo, Egypt: Hindawi Publishing Corporation</publisher><subject>Aged ; Aged, 80 and over ; Analysis ; Antifungal agents ; Antifungal Agents - administration & dosage ; Ascites ; Blood transfusions ; Catheters ; Data Interpretation, Statistical ; Disease prevention ; Female ; Fungal infections ; Health aspects ; Hepatitis B ; Hepatitis C ; Hospitals ; Humans ; Immunosuppressive agents ; Incidence ; Infection ; Liver ; Liver cancer ; Liver diseases ; Liver Transplantation - mortality ; Liver Transplantation - statistics & numerical data ; Male ; Medical prognosis ; Medicine ; Middle Aged ; Mortality ; Multivariate Analysis ; Mycoses ; Mycoses - mortality ; Mycoses - prevention & control ; Outcome Assessment (Health Care) - methods ; Premedication - mortality ; Premedication - statistics & numerical data ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; Surgical techniques ; Survival Rate ; Transplantation ; Transplants & implants ; Treatment Outcome ; Urine</subject><ispartof>BioMed research international, 2016-01, Vol.2016 (2016), p.1-7</ispartof><rights>Copyright © 2016 Yi-Chan Chen et al.</rights><rights>COPYRIGHT 2016 John Wiley & Sons, Inc.</rights><rights>Copyright © 2016 Yi-Chan Chen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2016 Yi-Chan Chen et al. 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-f9cbc131ccd3a556e497c69afc5d77164e521610f0d789f8737ab14f70835cfc3</citedby><cites>FETCH-LOGICAL-c532t-f9cbc131ccd3a556e497c69afc5d77164e521610f0d789f8737ab14f70835cfc3</cites><orcidid>0000-0002-2932-6878 ; 0000-0001-7245-9505 ; 0000-0002-3110-1598</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1827236480/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1827236480?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,25744,27915,27916,37003,37004,44581,74887</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27747235$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Kumar, Anand</contributor><creatorcontrib>Soong, Ruey-Shyang</creatorcontrib><creatorcontrib>Lee, Wei-Chen</creatorcontrib><creatorcontrib>Chou, Hong-Shiue</creatorcontrib><creatorcontrib>Wu, Ting-Jung</creatorcontrib><creatorcontrib>Lee, Chen-Fang</creatorcontrib><creatorcontrib>Cheng, Chih-Hsien</creatorcontrib><creatorcontrib>Wang, Yu-Chao</creatorcontrib><creatorcontrib>Huang, Ting-Shuo</creatorcontrib><creatorcontrib>Chen, Yi-Chan</creatorcontrib><creatorcontrib>Chan, Kun-Ming</creatorcontrib><title>Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach</title><title>BioMed research international</title><addtitle>Biomed Res Int</addtitle><description>Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors. Results. The cumulative hazards and transition probability of “transplantation to fungal infection” were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% ( p = 0.052 ); overall mortality improved from 40.8% to 23.4% ( p < 0.001 ). In the “transplantation to fungal infection” transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34–0.96, p = 0.033 ). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality. Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Antifungal agents</subject><subject>Antifungal Agents - administration & dosage</subject><subject>Ascites</subject><subject>Blood transfusions</subject><subject>Catheters</subject><subject>Data Interpretation, Statistical</subject><subject>Disease prevention</subject><subject>Female</subject><subject>Fungal infections</subject><subject>Health aspects</subject><subject>Hepatitis B</subject><subject>Hepatitis C</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Immunosuppressive agents</subject><subject>Incidence</subject><subject>Infection</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver diseases</subject><subject>Liver Transplantation - mortality</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Mycoses</subject><subject>Mycoses - mortality</subject><subject>Mycoses - prevention & control</subject><subject>Outcome Assessment (Health Care) - methods</subject><subject>Premedication - mortality</subject><subject>Premedication - statistics & numerical data</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Surgical techniques</subject><subject>Survival Rate</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Urine</subject><issn>2314-6133</issn><issn>2314-6141</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNqNkk9vFCEYxidGY5vam2dD4sVE1_JngMFDk0nTqsk2mljPhGVgh2YWRmBq9lv4kcu461o9lQvk5ceTl-d9quolgu8RovQMQ8TOGEaYQvKkOsYE1QuGavT0cCbkqDpN6RaW1SAGBXteHWHOa44JPa5-XVprdAbBgq8xjP12UDo7DVqfnZ38Wg1zPQcdhgSCB7k3c2HtQ3JpfrV0dyaCm6h8Ggfls8ou-A-g_S1nfHJ5C77pEA24Vln3zq-B8h24nobsUqFLPXRmAO04xqB0_6J6ZtWQzOl-P6m-X13eXHxaLL98_HzRLheaEpwXVuiVRgRp3RFFKTO14JoJZTXtOEesNhQjhqCFHW-EbTjhaoVqy2FDqLaanFTnO91xWm1Mp43PUQ1yjG6j4lYG5eS_N971ch3uJIWUYcKKwJu9QAw_JpOy3LikzVBMMGFKEjWEY9FQgR6D0poIAUlBX_-H3oYp-uJEoXCZGasb-Jcq8zHSeRtKi3oWlS3FkCNKGlGodztKx5BSNPbwOwTlHB85x0fu41PwVw8dOcB_wlKAtzugTLFTP90j5UxhjFUPaNHUCJF7fg3W8A</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Soong, Ruey-Shyang</creator><creator>Lee, Wei-Chen</creator><creator>Chou, Hong-Shiue</creator><creator>Wu, Ting-Jung</creator><creator>Lee, Chen-Fang</creator><creator>Cheng, Chih-Hsien</creator><creator>Wang, Yu-Chao</creator><creator>Huang, Ting-Shuo</creator><creator>Chen, Yi-Chan</creator><creator>Chan, Kun-Ming</creator><general>Hindawi Publishing Corporation</general><general>John Wiley & Sons, Inc</general><general>Hindawi Limited</general><scope>ADJCN</scope><scope>AHFXO</scope><scope>RHU</scope><scope>RHW</scope><scope>RHX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>CWDGH</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2932-6878</orcidid><orcidid>https://orcid.org/0000-0001-7245-9505</orcidid><orcidid>https://orcid.org/0000-0002-3110-1598</orcidid></search><sort><creationdate>20160101</creationdate><title>Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach</title><author>Soong, Ruey-Shyang ; Lee, Wei-Chen ; Chou, Hong-Shiue ; Wu, Ting-Jung ; Lee, Chen-Fang ; Cheng, Chih-Hsien ; Wang, Yu-Chao ; Huang, Ting-Shuo ; Chen, Yi-Chan ; Chan, Kun-Ming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-f9cbc131ccd3a556e497c69afc5d77164e521610f0d789f8737ab14f70835cfc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Antifungal agents</topic><topic>Antifungal Agents - administration & dosage</topic><topic>Ascites</topic><topic>Blood transfusions</topic><topic>Catheters</topic><topic>Data Interpretation, Statistical</topic><topic>Disease prevention</topic><topic>Female</topic><topic>Fungal infections</topic><topic>Health aspects</topic><topic>Hepatitis B</topic><topic>Hepatitis C</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Immunosuppressive agents</topic><topic>Incidence</topic><topic>Infection</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver diseases</topic><topic>Liver Transplantation - mortality</topic><topic>Liver Transplantation - statistics & numerical data</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>Mycoses</topic><topic>Mycoses - mortality</topic><topic>Mycoses - prevention & control</topic><topic>Outcome Assessment (Health Care) - methods</topic><topic>Premedication - mortality</topic><topic>Premedication - statistics & numerical data</topic><topic>Prognosis</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Surgical techniques</topic><topic>Survival Rate</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Urine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soong, Ruey-Shyang</creatorcontrib><creatorcontrib>Lee, Wei-Chen</creatorcontrib><creatorcontrib>Chou, Hong-Shiue</creatorcontrib><creatorcontrib>Wu, Ting-Jung</creatorcontrib><creatorcontrib>Lee, Chen-Fang</creatorcontrib><creatorcontrib>Cheng, Chih-Hsien</creatorcontrib><creatorcontrib>Wang, Yu-Chao</creatorcontrib><creatorcontrib>Huang, Ting-Shuo</creatorcontrib><creatorcontrib>Chen, Yi-Chan</creatorcontrib><creatorcontrib>Chan, Kun-Ming</creatorcontrib><collection>الدوريات العلمية والإحصائية - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BioMed research international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soong, Ruey-Shyang</au><au>Lee, Wei-Chen</au><au>Chou, Hong-Shiue</au><au>Wu, Ting-Jung</au><au>Lee, Chen-Fang</au><au>Cheng, Chih-Hsien</au><au>Wang, Yu-Chao</au><au>Huang, Ting-Shuo</au><au>Chen, Yi-Chan</au><au>Chan, Kun-Ming</au><au>Kumar, Anand</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach</atitle><jtitle>BioMed research international</jtitle><addtitle>Biomed Res Int</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>2016</volume><issue>2016</issue><spage>1</spage><epage>7</epage><pages>1-7</pages><issn>2314-6133</issn><eissn>2314-6141</eissn><abstract>Background. Whether routine antifungal prophylaxis decreases posttransplantation fungal infections in patients receiving orthotopic liver transplantation (OLT) remains unclear. This study aimed to determine the effectiveness of antifungal prophylaxis for patients receiving OLT. Patients and Methods. This is a retrospective analysis of a database at Chang Gung Memorial Hospital. We have been administering routine antibiotic and prophylactic antifungal regimens to recipients with high model for end-stage liver disease scores (>20) since 2009. After propensity score matching, 402 patients were enrolled. We conducted a multistate model to analyze the cumulative hazards, probability of fungal infections, and risk factors. Results. The cumulative hazards and transition probability of “transplantation to fungal infection” were lower in the prophylaxis group. The incidence rate of fungal infection after OLT decreased from 18.9% to 11.4% ( p = 0.052 ); overall mortality improved from 40.8% to 23.4% ( p < 0.001 ). In the “transplantation to fungal infection” transition, prophylaxis was significantly associated with reduced hazards for fungal infection (hazard ratio: 0.57, 95% confidence interval: 0.34–0.96, p = 0.033 ). Massive ascites, cadaver transplantation, and older age were significantly associated with higher risks for mortality. Conclusion. Prophylactic antifungal regimens in high-risk recipients might decrease the incidence of posttransplant fungal infections.</abstract><cop>Cairo, Egypt</cop><pub>Hindawi Publishing Corporation</pub><pmid>27747235</pmid><doi>10.1155/2016/6212503</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2932-6878</orcidid><orcidid>https://orcid.org/0000-0001-7245-9505</orcidid><orcidid>https://orcid.org/0000-0002-3110-1598</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2314-6133 |
| ispartof | BioMed research international, 2016-01, Vol.2016 (2016), p.1-7 |
| issn | 2314-6133 2314-6141 |
| language | eng |
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| source | Wiley Online Library Open Access; Publicly Available Content Database |
| subjects | Aged Aged, 80 and over Analysis Antifungal agents Antifungal Agents - administration & dosage Ascites Blood transfusions Catheters Data Interpretation, Statistical Disease prevention Female Fungal infections Health aspects Hepatitis B Hepatitis C Hospitals Humans Immunosuppressive agents Incidence Infection Liver Liver cancer Liver diseases Liver Transplantation - mortality Liver Transplantation - statistics & numerical data Male Medical prognosis Medicine Middle Aged Mortality Multivariate Analysis Mycoses Mycoses - mortality Mycoses - prevention & control Outcome Assessment (Health Care) - methods Premedication - mortality Premedication - statistics & numerical data Prognosis Propensity Score Proportional Hazards Models Reproducibility of Results Retrospective Studies Risk Factors Sensitivity and Specificity Surgical techniques Survival Rate Transplantation Transplants & implants Treatment Outcome Urine |
| title | Effect of Prophylactic Antifungal Protocols on the Prognosis of Liver Transplantation: A Propensity Score Matching and Multistate Model Approach |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-15T05%3A47%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20Prophylactic%20Antifungal%20Protocols%20on%20the%20Prognosis%20of%20Liver%20Transplantation:%20A%20Propensity%20Score%20Matching%20and%20Multistate%20Model%20Approach&rft.jtitle=BioMed%20research%20international&rft.au=Soong,%20Ruey-Shyang&rft.date=2016-01-01&rft.volume=2016&rft.issue=2016&rft.spage=1&rft.epage=7&rft.pages=1-7&rft.issn=2314-6133&rft.eissn=2314-6141&rft_id=info:doi/10.1155/2016/6212503&rft_dat=%3Cgale_pubme%3EA520715389%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c532t-f9cbc131ccd3a556e497c69afc5d77164e521610f0d789f8737ab14f70835cfc3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1827236480&rft_id=info:pmid/27747235&rft_galeid=A520715389&rfr_iscdi=true |