{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:58:00Z","timestamp":1791907080713,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T00:00:00Z","timestamp":1620000000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the rate of and the risk factors for breakthrough\u2010IFI (b\u2010IFI) after orthotopic liver transplantation (OLT) according to the new definition proposed by Mycoses\u2010Study\u2010Group\u2010Education\u2010and\u2010Research\u2010Consortium (MSG\u2010ERC) and the European\u2010Confederation\u2010of\u2010Medical\u2010Mycology (ECMM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Multicenter prospective study of adult patients who underwent OLT at three Italian hospitals, from January 2015 to December 2018. Targeted antifungal prophylaxis (TAP) protocol was developed and shared among participating centers. Follow\u2010up was 1\u2010year after OLT. B\u2010IFI was defined as infection occurring during exposure to antifungal prophylaxis. Risk factors for b\u2010IFI were analyzed among patients exposed to prophylaxis by univariable analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We enrolled 485 OLT patients. Overall compliance to TAP protocol was 64.3%, 220 patients received antifungal prophylaxis, 172 according to TAP protocol. Twenty\u2010nine patients were diagnosed of IFI within 1\u00a0year after OLT. Of them, 11 presented with b\u2010IFI within 17 (IQR 11\u201033) and 16 (IQR 4\u201030) days from OLT and from antifungal onset, respectively. Then out of 11 patients with b\u2010IFI were classified as having high risk of IFI and were receiving anti\u2010mould prophylaxis, nine with echinocandins and one with polyenes. Comparison of patients with and without b\u2010IFI showed significant differences for prior Candida colonization, need of renal replacement therapy after OLT, re\u2010operation, and CMV infection (whole blood CMV\u2010DNA &gt;100\u00a0000 copies\/mL). Although non\u2010significant, a higher rate of b\u2010IFI in patients on echinocandins was observed (8.2% vs 1.8%, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.06).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We observed 5% of b\u2010IFI among OLT patients exposed to antifungal prophylaxis. The impact of echinocandins on b\u2010IFI risk in this setting should be further explored.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13608","type":"journal-article","created":{"date-parts":[[2021,3,26]],"date-time":"2021-03-26T07:42:27Z","timestamp":1616744547000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Breakthrough invasive fungal infection after liver transplantation in patients on targeted antifungal prophylaxis: A prospective multicentre study"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3568-5973","authenticated-orcid":false,"given":"Matteo","family":"Rinaldi","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bartoletti","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"},{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Ferrarese","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant Unit (Gastroenterology) Department of Surgery Oncology and Gastroenterology Surgical and Gastroenterological Sciences Padua University Hospital Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit Department of Nephrology Dialysis and Transplant Unit University Hospital of Modena Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Campoli","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Coladonato","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2687-4235","authenticated-orcid":false,"given":"Renato","family":"Pascale","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"},{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna Bologna 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Morelli","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine for the Treatment of Severe Organ Failure IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cescon","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences Alma Mater Studiorum University of Bologna Bologna Italy"},{"name":"Division of Liver and Multiorgan Transplant IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological, and Gastroenterological Sciences Hepatobiliary Surgery and Liver Transplantation Unit Padua University Hospital Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Di Benedetto","sequence":"additional","affiliation":[{"name":"Hepato\u2010Pancreato\u2010Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio Emilia Modena Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Burra","sequence":"additional","affiliation":[{"name":"Multivisceral Transplant Unit (Gastroenterology) Department of Surgery Oncology and Gastroenterology Surgical and Gastroenterological Sciences Padua University Hospital Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Mussini","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit Department of Nephrology Dialysis and Transplant Unit University Hospital of Modena Modena 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