%0 Journal Article
%A López Medrano, Francisco
%A Muñoz de la Espada, M.
%A Pérez-Jacoiste Asín, María Asunción
%A Fernández Ruiz, Mario
%A Herrero Martínez, Juan María
%A Alonso-Carrillo, J.
%A San Juan Garrido, Rafael
%A Rodríguez Gonzer, Isabel
%A Andrés Belmonte, Amado
%A González Monte, Esther
%A Manrique Municio, Alejandro
%A Justo Alonso, Iago
%A Marcacuzco Quinto, Alberto Alejandro
%A Loinaz Segurola, Carmelo
%A Jiménez, C.
%A Lumbreras Bermejo, Carlos Juan
%A Aguado García, José María
%T Fluconazole versus micafungin for initial antifungal prophylaxis against Candida in pancreas transplant recipients: A comparative study of two consecutive periods.
%D 2022
%U https://hdl.handle.net/20.500.14352/129704
%X BackgroundInvasive fungal infection, particularly intraabdominal candidiasis, exerts a negative impact on the outcome of pancreas transplant recipients (PTRs). Optimal antifungal prophylaxis in this context remains unclear.MethodsWe performed a single-centre retrospective study to compare the incidence of invasive candidiasis during the first 6 post-transplant months in a cohort of 218 PTRs over two periods in which different agents for antifungal prophylaxis were used: fluconazole (Fluco-Px) from March 1995 to June 2012, and micafungin followed by fluconazole (Mica-Px) from July 2012 to December 2018.ResultsA total of 152 and 66 PTRs received Fluco-Px and Mica-Px. Mean age was 39.7 ± 7.8 years, 56.4% (123/218) were males, and 85.3% (186/218) underwent simultaneous pancreas–kidney transplantation. Invasive candidiasis occurred in 21.7% (33/152) of PTRs under Fluco-Px compared to 24.2% (16/66) of those under Mica-Px (p-value = .681). Median time from transplantation to infection was 8 days (interquartile range [IQR]: 6–16) under Fluco-Px versus 6.5 (IQR: 3.3–15.8) under Mica-Px (p-value = .623). Non-albicans Candida species comprised 27.5% (11/40) and 25.0% (4/16) of episodes under Fluco-Px and Mica-Px respectively (p-value = .849). Surgical site infection was the most common form in both groups (82.5% [33/40] and 87.5% [14/16]; p-value = .954). Multivariable analysis identified cold ischaemia time of the pancreas and kidney grafts, surgical reintervention and insulin requirement after transplantation as risks factor for invasive candidiasis.ConclusionThis retrospective study did not reveal a significant benefit from the initial use of micafungin-based antifungal prophylaxis over fluconazole among PTRs in terms of invasive candidiasis.
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