Abstract | OBJECTIVE: To compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis. METHODS: This was a single-center, retrospective, non-inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis ( nystatin group) or no antifungal prophylaxis therapy ( No PPX group). The primary outcome was the incidence of OC within 3 months post-transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre-specified non-inferiority margin was 10%. RESULTS: The incidence of OC within 3 months post-transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, -2.7% to 9.1%, non-inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3-34.3 days) in the nystatin group and 9.5 days (IQR 5.3-30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day. CONCLUSIONS: In this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non-inferiority to 30-day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.
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Authors | Trung Q Ky, Jeong M Park, Katie A McMurry, Sarah M Tischer, Linda J Fitzgerald, Laura Cotiguala |
Journal | Transplant infectious disease : an official journal of the Transplantation Society
(Transpl Infect Dis)
Vol. 23
Issue 3
Pg. e13559
(Jun 2021)
ISSN: 1399-3062 [Electronic] Denmark |
PMID | 33387388
(Publication Type: Journal Article)
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Copyright | © 2021 Wiley Periodicals LLC. |
Chemical References |
- Antifungal Agents
- Nystatin
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Topics |
- Antifungal Agents
(therapeutic use)
- Candidiasis, Oral
(drug therapy, prevention & control)
- Humans
- Kidney Transplantation
- Nystatin
(therapeutic use)
- Retrospective Studies
- Transplant Recipients
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