Safety and effectiveness of antifungal prophylaxis in preventing fungal infection after liver transplantation: a meta-analysis of randomized clinical trials.

Fungal infections are widely recognized as a complication of liver transplantation, and their prevention and treatment are a challenge for clinicians.This was a randomized clinical trial (RCT)-based meta-analysis investigating the safety and effectiveness of antifungal prophylaxis in preventing fungal infection after liver transplantation. Studies published before December 2013 were searched for in several databases. Patients who underwent antifungal prophylaxis were included in the treatment group. Studies that met the inclusion criteria were included in this meta-analysis. Quality assessment, data extraction, and statistical analysis were performed.A total of 342 articles was identified, and 7 eligible articles were included in the present study. The pooled estimate of the OR for all-cause mortality was 0.82 (95% confidence interval (CI): 0.51 - 1.30, p = 0.39). The pooled estimate of the OR of fungal infection-related mortality was 0.29 (95% CI: 0.11 - 0.75, p = 0.01), which was significantly different between the treatment and control groups. The pooled estimate of the OR of defined invasive fungal infection was 0.41 (95% CI: 0.26 - 0.63, p < 0.001). The OR of adverse events was 1.20 (95% CI: 0.68 - 2.12, p = 0.53).This meta-analysis suggests that antifungal prophylaxis could effectively reduce the risk of invasive fungal infections in patients who underwent liver transplantation. Overall mortality rate was not different with prophylaxis, according to current evidence. This needs to be further investigated.