Successful Treatment of Invasive Mucormycosis in Orthotopic Liver Transplant Population

Table 1

Immunosuppression induction and maintenance therapy.

	Patient 1		Patient 2		Patient 3
	Induction^1	Maintenance	Induction	Maintenance	Induction	Maintenance
Immunosuppression regimen prior to mucormycosis treatment	Steroids^2	(1) Tacrolimus; (2) Mycophenolate mofetil 1000 mg every 12 hours; (3) Prednisone 10 mg daily	Steroids^2	(1) Tacrolimus; (2) Mycophenolate mofetil 1000 mg every 12 hours; (3) Prednisone 15 mg daily	Steroids^2	(1) Tacrolimus; (2) Mycophenolate mofetil 500 mg every 12 hours; (3) Prednisone 20 mg daily
Immunosuppression regimen during mucormycosis treatment	(1) Tacrolimus; (2) Mycophenolate mofetil 250 BID; (3) Prednisone 5 mg daily		(1) Tacrolimus; (2) Mycophenolate mofetil held; (3) Prednisone 5 mg daily		(1) Tacrolimus; (2) Mycophenolate mofetil held; (3) Prednisone 5 mg daily
Targeted FK506 level before and during mucormycosis treatment	Before: 8–10 ng/mL; During: 4–6 ng/mL		Before: 6–8 ng/mL; During: 3–5 ng/mL		Before: 6–8 ng/mL; During: 3–5 ng/mL

Oral medication formulation unless otherwise noted. ¹Simultaneous liver-kidney transplant 20 months prior to mucormycosis event. ²Steroid induction followed by taper per institutional protocol: IV methylprednisolone 500 mg POD0, 200 mg POD1, 160 mg POD2, 120 mg POD3, 80 mg POD4, 40 mg POD5, and then prednisone 20 mg PO daily.