New study examines safe micafungin dosing after pediatric liver transplantation

Micafungin administration following pediatric living-donor liver transplantation (LDLT) is both safe and effective, according to a study.

Children undergoing LDLT often require long-term antibiotic treatment, but the appropriate dosage of micafungin post-transplantation had been uncertain.

The study aimed to determine the safety and efficacy of micafungin in pediatric patients after LDLT. A standard dose of 1 mg/kg of micafungin once daily was administered for 10 days starting on postoperative day (POD) 1.

Ten pediatric patients participated in the study, with a median age of 1.2 years. The primary diseases leading to transplantation included biliary atresia, Alagille syndrome, and progressive familial intrahepatic cholestasis type 2.

Results showed that micafungin levels remained within safe and effective ranges throughout the treatment period. Mean peak micafungin levels ranged from 4.47 to 6.27 µg/mL, while mean trough levels ranged from 1.88 to 2.66 µg/mL. Additionally, micafungin half-lives remained consistent between 13.7 and 14.7 hours across different postoperative days.

Beta D glucan levels, indicative of fungal infection, showed no significant difference before and after transplantation, suggesting the efficacy of micafungin in preventing fungal infections. Notably, no clinical fungal infections were observed in any of the patients during the study period.

Reference
Ueno T, Takase K, Deguchi K, et al. Plasma Concentration of Antifungal Agent Micafungin for Pediatric Living Donor Liver Transplantation. Transplant Proc. 2024;S0041-1345(24)00020-4. doi: 10.1016/j.transproceed.2024.01.020. Epub ahead of print. PMID: 38326203.