- 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 |