Table 5.
Post transplant prophylaxis | Comment |
PJP prophylaxis | Trimethoprim/sulfamethoxazole SS one tablet daily life long |
Alternatives: Dapsone 100 mg daily, pentamidine 300 mg inhaled or iv monthly or atovaquone 1500 mg daily[54] | |
CMV | Valganciclovir 900 mg daily1; oral (1 g tid) or iv (5 mg/kg daily) ganciclovir for 3 mo in D+/R-; prophylaxis or pre-emptive monitoring and therapy in R+ |
Fungal | High risk patients2 should receive Fluconazole 400 mg po daily × 14 d minimum[100] |
HBV (in HBV co-infected patients) | Life long HBIG targeting 100 IU/L plus either tenofovir or entecavir |
Valganciclovir is not FDA approved for use in liver transplantation; many centers use this agent off label[101];
High risk features include repeat or prolonged surgery, high transfusion requirements, renal failure, colonization with Candida or Choledochojejunostomy[100]. PJP: Pneumocystis jeroveci pneumonia; SS: Single strength; CMV: Cytomegalovirus; HBV: Hepatitis B virus; HBIG: Hepatitis B immunoglobulin; FDA: United States Food and Drug Administration.