CANDIDA COLONIZATION IN ORTHOTOPIC LIVER-TRANSPLANTATION - FLUCONAZOLE VERSUS ORAL AMPHOTERICIN-B

Liver transplant recipients are at high risk for invasive candidosis d ue to the elevated rate of Candida colonization. With the aim of ident ifying an effective prophylaxis, a randomized 3-year study was conduct ed on 75 liver transplanted patients in the Liver Transplantation Depa rtment of the University of Milan to compare the efficacy of intraveno us/oral fluconazole (200 mg/day) versus oral amphotericin B (6,000 mg/ day). Patients were randomized to one of the two antifungal prophylaxi s 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 eval uable patients allocated to amphotericin B and 20/38 allocated to fluc onazole. Candida albicans was the most frequently isolated species (de tected in 17 and 11 patients in the amphotericin B and fluconazole gro ups, respectively). Amphotericin B cleared 12/21 colonizations, includ ing 8 caused by C. albicans, and prevented Candida colonization in 11/ 13 patients. Fluconazole cured the 11 patients colonized by C. albican s but was ineffective against C. glabrata and C. krusei colonization i n 9 cases. Colonization was prevented by the triazole in all 18 patien ts whose mucous membranes were not colonized at the time of transplant . Both antifungals were safe and well tolerated and no interaction wit h cyclosporin A was evident during fluconazole treatment. Fluconazole seems the antifungal of choice for prophylaxis in liver transplant rec ipients 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. kr usei may be overcome by mycological surveillance enabling a prompt cha nge of antifungal in presence of colonization by these species. In add ition, administration of the triazole (once daily, intravenously/orall y) is more convenient thant that of amphotericin B (every 6 hours, per os and by nasogastric tribe, if present).