Effective fluconazole therapy for liver transplant recipients during continuous hemodiafiltration

Fungal infections are still one of the main causes of death and complicatio ns after solid organ and bone marrow transplants. The authors evaluated the effect of continuous hemodiafiltration (CHDF) on the pharmacokinetics of f luconazole in liver transplant recipients. Six liver transplant patients (p rimary biliary cirrhosis, n = 2; fulminant hepatitis, n = 2: viral hepatiti s, n = 2) were enrolled in this study. In one patient not receiving CHDF, t he fluconazole levels increased with increasing dosages. in contrast, in pa tients undergoing CHDF, the dosage of fluconazole was increased from 100 mg /d to 200 mg/d, but fluconazole did not reach the targeted levels. It appea rs that the targeted trough level cannot be achieved by administration of f luconazole at a dosage of 100 to 200 mg/d during CHDF. A higher dosage (600 -1000 mg/d) of fluconazole may be required to achieve the therapeutic drug level in patients undergoing CHDF. In patients undergoing CHDF, fluconazole was given at a dosage of 800 mg/d and reached the targeted levels. In addi tion, after CHDF, the dosage of fluconazole was decreased to 100 mg/d, and fluconazole reached the near-targeted trough level. These results demonstra te that CHDF removes fluconazole from the blood at an Efficiently high rate , resulting in its ineffective blood level. To guarantee safe and effective fluconazole therapy, the trough levels should be monitored routinely durin g CHDF.