Authors: Sarina Panagiotopoulos, PharmD; Kayla Joyal, PharmD; Camille Kotton, MD; Helena Torpy, MD Learning Objective: At the conclusion of the presentation, the participant will be able to evaluate the efficacy of 72 hours of fluconazole for prevention of invasive candidiasis (IC) in liver transplant. Background/Objective: Invasive candidiasis causes significant morbidity and mortality in liver transplant recipients, and prophylaxis duration is not well defined. This study evaluates 72-hour fluconazole prophylaxis to prevent IC within 35 days post-transplant. Methods: This retrospective, observational, single-center study included adult patients who underwent liver transplantation at Massachusetts General Hospital (MGH) between January 1 and December 31, 2025. Patients who died within 30 days of transplant from non-fungal causes and those on antifungal treatment without definitive IC were excluded. The primary outcome was definitive IC within 35 days post-transplant, defined by EORTC/MSGERC criteria. Secondary outcomes included antifungal prophylaxis agent and duration, positive fungal cultures, and antifungal treatment regimens and duration for IC. Results: 78% of transplants (N=146) received antifungal prophylaxis. Out of the transplants that received prophylaxis, 95% (N=139) received fluconazole, 3% (N=4) received fluconazole followed by micafungin, and 2% (N=3) received micafungin. The median prophylaxis duration was 3.4 days (IQR 2.0-4.0). IC occurred in 5.4% of all patients (N=10), nine of which had positive peritoneal fluid cultures and one of which had a positive surgical site culture. All cases of IC occurred after at least 48 hours of prophylaxis. IC occurred in 8.2% of patients (N=4) that received 48 hours of fluconazole prophylaxis (N=49) and in 5.8% of patients (N=3) that received 72 hours of fluconazole. Conclusions: The rate of IC after 72 hours of fluconazole is low and comparable to results of recent studies that utilized longer antifungal durations. This study supports efficacy of 72 hours of fluconazole for preventing IC in liver transplant at MGH. Self-Assessment Question: What are risk factors for IC in liver transplant?
