REVIEW Systematic review and meta-analysis of antifungal agents for preventing fungal infections in liver transplant recipients E. G. Playford & A. C. Webster & T. C. Sorrell & J. C. Craig Published online: 16 August 2006 # Springer-Verlag 2006 Abstract A systematic review and meta-analysis was performed to evaluate the benefits and harms of antifungal prophylaxis in liver transplant recipients. Ten randomised trials comparing any prophylactic antifungal regimen with no antifungal agent or with another antifungal regimen were identified from Medline, EMBASE, the Cochrane Library, and other sources. Together, the studies included a total of 1,106 patients. In general, results were consistent across trials despite clinical and methodological heteroge- neity. Antifungal prophylaxis did not reduce total mortality (RR 0.84, 95% CI: 0.54–1.3). Fluconazole prophylaxis reduced invasive fungal infections by about 75% (RR 0.28, 95% CI: 0.13–0.57). Although fewer data on prophylactic itraconazole and liposomal amphotericin B were available, indirect comparisons and three direct comparative trials suggested similar efficacy. Fluconazole prophylaxis did not significantly increase colonisation or infection with azole- resistant fungi, although data were limited. A subgroup analysis suggested a dose and duration effect. In conclu- sion, fluconazole prophylaxis significantly reduces invasive fungal infections in liver transplant recipients and should be instituted in patients at increased risk in the early postoperative period. Keywords Meta-analysis . Antifungal . Liver transplant Introduction Invasive fungal infections are important causes of morbidity and mortality amongst immunocompromised patients such as solid organ transplant recipients [1, 2]. The risk is greatest during the early post-transplant period [3] and varies with the type of transplant: liver (7–42%), heart (5–21%), lung (15–35%), and pancreas (18–35%) transplant recipients are at greater risk than renal transplant recipients (1–14%) [3, 4]. The clinical consequences of invasive fungal infections in liver transplant recipients are considerable, with reported mortality rates of 36–70% for invasive candidiasis [5, 6] and Eur J Clin Microbiol Infect Dis (2006) 25:549–561 DOI 10.1007/s10096-006-0182-3 Presented in part at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL, USA, 14–17 September 2003, Abstract no. M-968. Potential conflicts of interest: E.G.P. is a member of the Mycology Interest Group of the Australasian Society for Infectious Diseases, which is sponsored by Gilead, Pfizer, and Merck. T.C.S. has advisory board involvement with Pfizer, Merck, and Gilead, has received unrelated project funding from Pfizer, Merck, and Gilead, and is a member of the Mycology Interest Group of the Australasian Society for Infectious Diseases, which is sponsored by Gilead, Pfizer, and Merck. E. G. Playford (*) Infection Management Services, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane Qld 4102, Australia e-mail: geoffrey_playford@health.qld.gov.au E. G. Playford : T. C. Sorrell Department of Medicine, University of Sydney, Sydney NSW 2006, Australia E. G. Playford : T. C. Sorrell Centre for Infectious Diseases and Microbiology, University of Sydney (Western Clinical School), Westmead NSW 2145, Australia A. C. Webster : J. C. Craig School of Public Health, University of Sydney, Sydney NSW 2006, Australia A. C. Webster : J. C. Craig Cochrane Renal Group, Centre for Kidney Research, Children’ s Hospital at Westmead, Westmead NSW 2145, Australia