Gatti M, Rinaldi M, Ferraro G, et al. - This study’s findings demonstrate that echinocandins do not appear to be correlated with an elevated risk of breakthrough invasive fungal infections (IFIs) in orthotopic liver transplant (OLT) recipients. However, the large diversity in the comparator group hinders a definitive interpretation. There is a need for further studies to explore the association between echinocandin use and breakthrough IFIs according to specific comparators.

• Researchers screened 698 articles, and ten studies (3 [randomized controlled trials (RCTs]) and 7 observational studies) were enrolled.

• The results showed that no variation between echinocandins and other antifungals in terms of breakthrough IFIs at the end of prophylaxis (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).

• As per the finding, no difference emerged also for secondary outcomes.

• There was a trend for the higher risk of breakthrough IFI at the EOP (OR 4.82, 95% CI 0.97–24.03) in the subgroup comparison between echinocandins and polyenes.