Evidence map›Paper›PMID 34387004›Full record

SynthesisMycoses2021

Breakthrough invasive fungal infections in liver transplant recipients exposed to prophylaxis with echinocandins vs other antifungal agents: A systematic review and meta-analysis.

Milo Gatti, Matteo Rinaldi, Giuseppe Ferraro, Alice Toschi, Natascia Caroccia, Federica Arbizzani, Emanuel Raschi, Elisabetta Poluzzi, Federico Pea, Pierluigi Viale and 1 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Mycoses, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
0.3field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Role of liposomal amphotericin B in intensive care unit: an expert opinion paper.Journal of anesthesia, analgesia and critical care · 2025
    Review
  5. Article
  6. Article
  7. Review
  8. Risk factors associated with invasive fungal disease post-liver transplantation.The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Milo GattiDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.ORCID https://orcid.org/0000-0003-3018-3779
Matteo RinaldiInfectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.ORCID https://orcid.org/0000-0002-3568-5973
Giuseppe FerraroInfectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Alice ToschiInfectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Natascia CarocciaInfectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Federica ArbizzaniInfectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Emanuel RaschiDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Elisabetta PoluzziDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Federico PeaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Pierluigi VialeDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Maddalena GiannellaDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Azienda USL di Bologna · ITUniversity of Bologna · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAlthough echinocandins are recommended as first-line prophylaxis for high-risk orthotopic liver transplant (OLT) recipients, occurrence of breakthrough-invasive fungal infections (IFIs) remains a serious concern. We aim to assess the risk of breakthrough IFIs among OLT recipients exposed to prophylaxis with echinocandins compared to other antifungals. MATERIALS AND

methodsTwo authors independently searched PubMed-MEDLINE, Embase, study registries and reference lists from inception to March 2021, to retrieve randomised controlled trials (RCTs) or observational studies comparing efficacy and safety of echinocandins vs other antifungals for prophylaxis in OLT recipients. Data were independently extracted from two authors, and the quality of included studies was independently assessed according to ROB 2.0 tool for RCTs and ROBINS-I tool for observational studies. The primary outcome was occurrence of breakthrough IFI at the end of prophylaxis (EOP).

results698 articles were screened, and ten studies (3 RCTs and 7 observational) were included. No difference between echinocandins and other antifungals in terms of breakthrough IFIs at the EOP emerged both from RCTs (odds ratio [OR] 0.85, 95% CI 0.24-2.99) and observational studies (OR 1.43, 95% CI 0.28-7.40). No difference emerged also for secondary outcomes. In the subgroup comparison between echinocandins and polyenes, a trend for higher risk of breakthrough IFI at the EOP (OR 4.82, 95% CI 0.97-24.03) was noted.

conclusionsEchinocandins do not seem to be associated with increased risk of breakthrough IFIs in OLT recipients. However, the large diversity in the comparator group hinders a definitive interpretation. Further studies exploring the relationship between echinocandin use and breakthrough IFIs according to specific comparators are warranted.

Indexed as

Liver TransplantationTransplant RecipientsAdultAgedAntifungal AgentsEchinocandinsFemaleHumansInvasive Fungal InfectionsMaleMiddle AgedObservational Studies as TopicOdds RatioProspective StudiesRandomized Controlled Trials as TopicRetrospective StudiesAntifungal AgentsEchinocandinsantifungal prophylaxisbreakthrough-invasive fungal infectionechinocandinsliver transplant recipients

Identifiers

PMID34387004
PMCPMC9292189
OpenAlexW3189859337

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.