Selection of Resistant Fungi in Liver Transplant Recipients During Use of Newer Antifungal Agents — A Report of Two Cases

Abstract

Introduction: Because invasive fungal infections cause significant morbidity and mortality in liver transplant recipients, the use of antifungal prophylaxis, and the early empirical use of antifungal agents, is widespread on liver transplant units. The new-generation azoles such as voriconazole and the echinocandins have been welcome additions to the antifungal armamentarium. These agents have become the leading options for prophylaxis in liver transplant units, despite the absence of strong data for their efficacy in this setting. Clinical picture: We report two recipients of living-donor liver transplants who became infected/colonised with fungi resistant to an echinocandin and the azoles after exposure to these agents. One patient developed trichosporonosis while on caspofungin and the other became infected/ colonised with Candida glabrata that was resistant to voriconazole and posaconazole. Conclusion: We report these to highlight some of the consequences of using the newer antifungal agents. Key words: Caspofungin, Echinocandin, Fluconazole resistance, Liver transplantation, Trichosporon, Voriconazole