Table 10.

- Prophylactic strategies for common microorganisms that affect LT recipients.

Organism	Drug/Dosage	Duration	Comments
CMV
Donor-positive/recipient-negative	Valganciclovir (900 mg/day) or intravenous ganciclovir (5 mg/kg/day)	3-6 months	Valganciclovir is not FDA-approved for LT. Prolonged-duration regimens are effective in kidney transplantation.
Recipient-positive	Valganciclovir (900 mg/day), intravenous ganciclovir, or weekly CMV viral load monitoring and antiviral initiation when viremia is identified	3 months	Valganciclovir is not FDA-approved for LT.
Fungi	Fluconazole (100-400 mg daily), itraconazole (200 mg twice daily), caspofungin (50 mg daily), or liposomal amphotericin (1 mg/kg/day)	4-6 weeks (adjust duration)	Reserve for high-risk individuals (pretransplant fungal colonization, renal replacement therapy, massive transfusion, choledochojejunostomy, re-operation, re-transplantation, or hepatic iron overload).
P. jirovecii (P. carinii)	Trimethoprim sulfamethoxazole (single strength daily or double strength 3 times per week), dapsone (100 mg daily), or atovaquone (1500 mg daily)	6-12 months (adjust duration)	A longer duration of therapy should be considered for patients on augmented immunosuppression. Lifelong therapy should be considered for HIV-infected recipients.
TB (latent infection)	Isoniazid (300 mg daily)	9 months	Monitor for hepatotoxicity