Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

Ky, Trung Q; Park, Jeong Mi; McMurry, Katie; Tischer, Sarah; Fitzgerald, Linda J; Cotiguala, Laura

doi:10.1111/tid.13559

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…The decision to stop using clotrimazole prophylaxis did not have clinical impact on candidiasis as there was not a statistically significant difference in its incidence between groups, although there were more cases of oropharyngeal candidiasis among those who did not receive prophylaxis (4.3% incidence). This observed incidence is lower than that seen in a similar single‐center study conducted by Ky et al., in which oropharyngeal candidiasis within 3 months post‐kidney transplant was seen in 7.8% of those not receiving nystatin prophylaxis 10 …”

Section: Discussionmentioning

confidence: 99%

“…This observed incidence is lower than that seen in a similar single-center study conducted by Ky et al, in which oropharyngeal candidiasis within 3 months post-kidney transplant was seen in 7.8% of those not receiving nystatin prophylaxis. 10 An inherent limitation of this study is its retrospective design, which limited the overall sample size and the ability to control for adjustments in tacrolimus dosing. Specifically, adjustments between the time of tacrolimus initiation and first recorded trough, as well as adjustments between the time of clotrimazole discontinuation and the first recorded trough post-discontinuation were unable to be captured.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients

Wings

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Eckardt

2022

Transplant Infectious Dis

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Background: Clotrimazole troches are used as prophylaxis against oropharyngeal candidiasis post-transplant and have limited systemic absorption. Following several occurrences of tacrolimus concentration fluctuations after clotrimazole discontinuation, its use as prophylaxis was discontinued post-kidney transplant. Methods:We conducted a retrospective cohort study to evaluate the effect of clotrimazole prophylaxis on tacrolimus trough concentrations post-kidney transplant.The study included adult patients who received a kidney transplant at Cleveland Clinic Main Campus from August 1, 2019 to July 1, 2020 and were maintained on per-protocol, standard-dose tacrolimus through 90 days post-transplant. Patients were excluded if they received cyclosporine, systemic antifungals, strong CYP3A4 inhibitors or inducers, or a simultaneous multiorgan transplant. The primary objective was to compare tacrolimus trough concentrations before and after completion of clotrimazole prophylaxis. Secondary objectives were to compare the time to first post-transplant goal tacrolimus trough concentration, the rate of for-cause allograft biopsies within 90 days after transplant, and the incidence and type of candidiasis within 30 days after transplant, pre-and post-protocol change.Results: Following clotrimazole discontinuation, the median tacrolimus trough concentration decreased from 10.5 ng/ml (IQR 8.4-12.2) to 6.6 ng/ml (IQR 5-8.7, p < 0.0001).No statistically significant differences in the rate of for-cause allograft biopsies (4.9% vs. 9.7%, p = 0.264) or incidence of candidiasis (1.2% vs. 5.4%, p = 0.217) were observed between those who received clotrimazole and those who did not receive clotrimazole. Conclusions:Our study provides further evidence of a significant drug-drug interaction between tacrolimus and clotrimazole among kidney transplant recipients that can potentially lead to negative allograft outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients

Wings

Spinner

Eckardt

2022

Transplant Infectious Dis

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“…At our hospital, we do not perform candidiasis prophylaxis early after transplantation. Previous reports have indicated that prophylactic administration of antifungal drugs is non‐inferior with respect to the development of oral candidiasis 12 . However, it is possible that over‐immunosuppressive conditions may be overlooked in facilities where antifungal drugs are administered prophylactically after kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation

et al. 2021

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Aim Bacterial and fungal infections are serious, life‐threatening conditions after kidney transplantation. The development of oral/oesophageal candidiasis after kidney transplantation is not a reported risk factor for subsequent severe infection. This study was performed to investigate the relationship between oral/oesophageal candidiasis after kidney transplantation and the development of subsequent infection requiring hospitalization. Methods This retrospective study included 522 consecutive patients who underwent kidney transplantation at Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital from 1 January 2010 to 1 February 2019. Ninety‐five percentage of patients were living donor transplant recipients. Visual examination was performed to detect oral candidiasis, beginning immediately after kidney transplantation; upper gastrointestinal endoscopy was performed 8–10 months after kidney transplantation. Twenty‐five patients developed candidiasis (Candida‐onset group) and 497 did not (non‐Candida‐onset group). The follow‐up periods were 67 (37–86) months in the Candida‐onset group and 55 (34–89) months in the non‐Candida‐onset group. Severe infection was defined as bacterial or fungal infection requiring hospitalization; viral infections were excluded. Results Severe infection developed in 9/25 (36%) patients in the Candida‐onset group and in 77/497 (15%) patients in the non‐Candida‐onset group (p = .006). Binomial logistic analysis revealed that Candida infection (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.06–6.06; p = .037) and use of rituximab (OR 1.81, 95% CI 1.12–2.93; p = .016) were significant predictors of subsequent severe infection. Conclusion Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation and suggests an over‐immunosuppressive state, which should prompt evaluation of immunosuppression.

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Infectious Disease Prophylaxis During and After Immunosuppressive Therapy

Schweitzer,

Miko,

Pereira

2024

Kidney International Reports

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Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

Cited by 3 publications

References 17 publications

Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients

Evaluation of clotrimazole prophylaxis on tacrolimus trough concentrations in kidney transplant recipients

Oral/oesophageal candidiasis is a risk factor for severe infection after kidney transplantation

Infectious Disease Prophylaxis During and After Immunosuppressive Therapy

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