BACKGROUND: Invasive fungal infections (IFI) are associated with high mortality in liver transplant recipients. Prevention remains an elusive goal, especially for IFI caused by moulds. PATIENTS AND METHODS: From January 1998, patients who fulfilled four or more variables identified as risk factors for IFI received a cumulative dose of 1-1.5 g of lipid formulations of amphotericin B (L-AmpB; AmBisome or Abelcet). The development of IFI in these patients was compared with historical patients. RESULTS: Two hundred and eighty liver transplant recipients were analysed over a period of 8 years. In the historical group, IFI were observed in 22 of 131 patients (17%) and invasive aspergillosis in 13 of them (10%). After January 1998, IFI were observed in nine of 149 (6%) (P < 0.01) and invasive aspergillosis in six patients (4%) (P = 0.08). In patients with four or more risk factors (high risk) for IFI, the administration of L-AmpB reduced the risk from 36% to 14% (P = 0.07), and the risk of aspergillosis from 23% to 5% (P = 0.08). Notably, prophylaxis reduced the risk of aspergillosis from 32% to 0% in dialysed patients (P = 0.03). Variables independently associated with IFI in high-risk patients were dialysis [odds ratio (OR) 3.9; 95% confidence interval (CI) 1-16.7] and surgical reintervention (OR 5.4; 95% CI 1.2-24.6), while L-AmpB was a protective factor in this multivariate analysis (OR 0.1; 95% CI 0.02-0.8). The analysis in these high-risk patients was not able to demonstrate an association between the administration of L-AmpB and higher survival. CONCLUSIONS: Selected risk factors are good predictors of IFI in liver transplant recipients. The administration of L-AmpB in high-risk patients is independently associated with a reduction of IFI.
BACKGROUND:Invasive fungal infections (IFI) are associated with high mortality in liver transplant recipients. Prevention remains an elusive goal, especially for IFI caused by moulds. PATIENTS AND METHODS: From January 1998, patients who fulfilled four or more variables identified as risk factors for IFI received a cumulative dose of 1-1.5 g of lipid formulations of amphotericin B (L-AmpB; AmBisome or Abelcet). The development of IFI in these patients was compared with historical patients. RESULTS: Two hundred and eighty liver transplant recipients were analysed over a period of 8 years. In the historical group, IFI were observed in 22 of 131 patients (17%) and invasive aspergillosis in 13 of them (10%). After January 1998, IFI were observed in nine of 149 (6%) (P < 0.01) and invasive aspergillosis in six patients (4%) (P = 0.08). In patients with four or more risk factors (high risk) for IFI, the administration of L-AmpB reduced the risk from 36% to 14% (P = 0.07), and the risk of aspergillosis from 23% to 5% (P = 0.08). Notably, prophylaxis reduced the risk of aspergillosis from 32% to 0% in dialysed patients (P = 0.03). Variables independently associated with IFI in high-risk patients were dialysis [odds ratio (OR) 3.9; 95% confidence interval (CI) 1-16.7] and surgical reintervention (OR 5.4; 95% CI 1.2-24.6), while L-AmpB was a protective factor in this multivariate analysis (OR 0.1; 95% CI 0.02-0.8). The analysis in these high-risk patients was not able to demonstrate an association between the administration of L-AmpB and higher survival. CONCLUSIONS: Selected risk factors are good predictors of IFI in liver transplant recipients. The administration of L-AmpB in high-risk patients is independently associated with a reduction of IFI.
Authors: Nina Singh; Barbara D Alexander; Olivier Lortholary; Francoise Dromer; Krishan L Gupta; George T John; Ramon del Busto; Goran B Klintmalm; Jyoti Somani; G Marshall Lyon; Kenneth Pursell; Valentina Stosor; Patricia Munoz; Ajit P Limaye; Andre C Kalil; Timothy L Pruett; Julia Garcia-Diaz; Atul Humar; Sally Houston; Andrew A House; Dannah Wray; Susan Orloff; Lorraine A Dowdy; Robert A Fisher; Joseph Heitman; Marilyn M Wagener; Shahid Husain Journal: J Infect Dis Date: 2007-01-23 Impact factor: 5.226
Authors: G A Eschenauer; E J Kwak; A Humar; B A Potoski; L G Clarke; R K Shields; R Abdel-Massih; F P Silveira; P Vergidis; C J Clancy; M H Nguyen Journal: Am J Transplant Date: 2014-10-30 Impact factor: 8.086
Authors: Hsin-Yun Sun; Barbara D Alexander; Olivier Lortholary; Francoise Dromer; Graeme N Forrest; G Marshall Lyon; Jyoti Somani; Krishan L Gupta; Ramon del Busto; Timothy L Pruett; Costi D Sifri; Ajit P Limaye; George T John; Goran B Klintmalm; Kenneth Pursell; Valentina Stosor; Michelle I Morris; Lorraine A Dowdy; Patricia Munoz; Andre C Kalil; Julia Garcia-Diaz; Susan Orloff; Andrew A House; Sally Houston; Dannah Wray; Shirish Huprikar; Leonard B Johnson; Atul Humar; Raymund R Razonable; Shahid Husain; Nina Singh Journal: Clin Infect Dis Date: 2009-12-01 Impact factor: 9.079