Prevention

For liver transplant recipients, oral bowel decontamination with nystatin decreases the rate of gut colonization with Candida species, but its benefit in reducing post-operative fungal infections is unclear. Although fluconazole has demonstrated efficacy in the prevention of Candida infection after liver transplantation, its universal use is discouraged because of the potential for emergence of azole-resistant fungi. Fluconazole prophylaxis is acceptable for high risk liver allograft recipients, especially in the setting of repeated surgeries, prolonged operation time, renal failure, and high intra-operative transfusion requirement. Fluconazole courses beyond four weeks are not warranted. In kidney and pancreas-kidney recipients, pre-emptive treatment of asymptomatic candiduria may be indicated. There is anecdotal efficacy reported with fluconazole prophylaxis after pancreas transplantation, and it may be considered for high risk recipients such as those with an enteric drainage procedure, pancreas after kidney transplantation, peritoneal dialysis before transplantation, reperfusion pancreatitis, and re-transplantation.

Aspergillus Species

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