JAC Advance Access published online on October 16, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg450
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Infectious Disease Department and Liver Transplant Group,
Hospital Ramon y Cajal, Crtra Colmenar Km 9.1, Madrid 28034, Spain
* Corresponding author. E-mail: fortun{at}mi.madritel.es.
Received 25 April 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
Prevention of invasive fungal infections in liver
transplant recipients: the role of prophylaxis with lipid formulations
of amphotericin B in high-risk patients
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