Outcomes and management of viral hepatitis and human immunodeficiency virus co-infection in liver transplantation

Table 5 Post transplant prophylaxis

Post transplant prophylaxis	Comment
PJP prophylaxis	Trimethoprim/sulfamethoxazole SS one tablet daily life long
	Alternatives: Dapsone 100 mg daily, pentamidine 300 mg inhaled or iv monthly or atovaquone 1500 mg daily[54]
CMV	Valganciclovir 900 mg daily1; oral (1 g tid) or iv (5 mg/kg daily) ganciclovir for 3 mo in D+/R-; prophylaxis or pre-emptive monitoring and therapy in R+
Fungal	High risk patients2 should receive Fluconazole 400 mg po daily × 14 d minimum[100]
HBV (in HBV co-infected patients)	Life long HBIG targeting 100 IU/L plus either tenofovir or entecavir

¹Valganciclovir is not FDA approved for use in liver transplantation; many centers use this agent off label[101];

²High risk features include repeat or prolonged surgery, high transfusion requirements, renal failure, colonization with Candida or Choledochojejunostomy[100]. PJP: Pneumocystis jeroveci pneumonia; SS: Single strength; CMV: Cytomegalovirus; HBV: Hepatitis B virus; HBIG: Hepatitis B immunoglobulin; FDA: United States Food and Drug Administration.