JAC Advance Access originally published online on October 16, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 813-819
© 2003 The British Society for Antimicrobial Chemotherapy
Prevention of invasive fungal infections in liver transplant recipients: the role of prophylaxis with lipid formulations of amphotericin B in high-risk patients
Infectious Disease Department and Liver Transplant Group, Hospital Ramon y Cajal, Crtra Colmenar Km 9.1, Madrid 28034, Spain
Received 25 April 2003; returned 1 June 2003; revised 12 August 2003; accepted 17 August 2003
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.
Keywords: Abelcet, AmBisome, Aspergillus, liver transplantation
* Corresponding author. Tel: +34-9133-68709; Fax: +34-9133-68792; E-mail: fortun{at}mi.madritel.es
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