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A Multicenter, Randomized, Open-Label Study to Compare Micafungin with Fluconazole in the Prophylaxis of Invasive Fungal Infections in Living-Donor Liver Transplant Recipients

 Woo-Hyoung Kang  ;  Gi-Won Song  ;  Sung-Gyu Lee  ;  Kyung-Suk Suh  ;  Kwang-Woong Lee  ;  Nam-Joon Yi  ;  Jae Won Joh  ;  Choon Hyuck David Kwon  ;  Jong Man Kim  ;  Dong Lak Choi  ;  Joo Dong Kim  ;  Myoung Soo Kim 
 JOURNAL OF GASTROINTESTINAL SURGERY, Vol.24(4) : 832-840, 2020-04 
Journal Title
Issue Date
Antifungal Agents / therapeutic use ; End Stage Liver Disease* ; Fluconazole / therapeutic use ; Hematopoietic Stem Cell Transplantation* ; Humans ; Invasive Fungal Infections* / drug therapy ; Lipopeptides ; Liver Transplantation* / adverse effects ; Living Donors ; Micafungin ; Middle Aged ; Mycoses* ; Severity of Illness Index
Micafungin ; Fluconazole ; Prophylaxis of invasive fungal infection ; Living donor liver transplantation
Background Although invasive fungal infections (IFIs) contribute to substantial morbidity and mortality in liver transplant recipients, only a few randomized studies analyzed the results of antifungal prophylaxis with echinocandins. The aim of this open-label, non-inferiority study was to evaluate the efficacy and safety of micafungin in the prophylaxis of IFIs in living-donor liver transplantation recipients (LDLTRs), with fluconazole as the comparator. Methods LDLTRs (N = 172) from five centers were randomized 1:1 to receive intravenous micafungin 100 mg/day or fluconazole 100~200 mg/day (intravenous or oral). A non-inferiority of micafungin was tested against fluconazole. Results The per-protocol set included 144 patients without major clinical trial protocol violations: 69 from the micafungin group and 75 from the fluconazole group. Mean age of the study patients was 54.2 years and mean model for end-stage liver disease (MELD) score amounted to 16.5. Clinical success rates in the micafungin and fluconazole groups were 95.65% and 96.10%, respectively (difference: - 0.45%; 90% confidence interval [CI]: - 6.93%, 5.59%), which demonstrated micafungin's non-inferiority (the lower bound for the 90% CI exceeded - 10%). The study groups did not differ significantly in terms of the secondary efficacy endpoints: absence of IFIs at the end of the prophylaxis and the end of the study, time to proven IFI, fungal-free survival, and adverse reactions. A total of 17 drug-related adverse events were observed in both groups; none of them was serious and all resolved. Conclusion Micafungin can be used as an alternative to fluconazole in the prevention of IFIs in LDLTRs.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
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