Performance Characteristics of Galactomannan and beta-d-Glucan in High-Risk Liver Transplant Recipients.
Singh N, Winston DJ, et al.Transplantation 2015 [record in progress]
Aims
To examine the performance characteristics of Aspergillus galactomannan (GM) and β-D-glucan (BG) levels in the diagnosis of invasive fungal infections (IFIs) in high-risk liver transplant recipients.
Interventions
Patients were randomized to receive either anidulafungin or fluconazole.
Participants
200 liver transplant recipients aged ≥18 years classified as high-risk
Outcomes
The primary outcome measured was the incidence of invasive fungal Infections (IFIs). GM and BG levels were also measured.
Follow-up
4 weeks
CET Conclusions
Biomarkers that detect circulating fungal cell wall constituents have been developed in the last decade and two such are, galactomannan (GM) and beta-d-glucan (BG). Galactomannan is a polysacceride cell wall component of Aspergillus, while beta-d-glucan is a cell wall constituent of candida species and other medically relevant fungi. These two biomarkers were assessed in a randomised double-blind clinical trial of anti-fungal prophylaxis in liver transplant recipients at high-risk of invasive fungal infection. In the trial itself, eligible high-risk patients were randomised to receive either anidulefungin or fluconazole. The patients were monitored at regular intervals for the above biomarkers, and several hundred assays of these biomarkers were available for analysis. This is the first study of a structured monitoring of GM and BG prospectively in an anti-fungal prophylaxis trial. A key finding of the study was that the base line markers were positive in a high proportion of the patients, GM in around 50% and BG in approximately 90%. Thus, the authors conclude, and I would agree, that GM and BG tests have limited clinical utility for the diagnosis of invasive fungal infections after liver transplantation. Therefore, the test reactivity of both GM and BG must be interpreted with considerable caution in view of the high rate of false positives.
Data analysis
Modified intention-to-treat analysis
Quality notes
Score based on the previous study Winston DJ, et al. Am J Transplant. 2014; 14(12):2758–2764.
Trial registration
ClinicalTrials.gov - NCT00841971