Fungal Infection Prophylaxis in High-Risk Liver Transplant Recipients.

E. VARO, S. TOME, M. BUSTAMANTE, J. MARTINEZ, J. PAREDES, R. CONDE, A. BRAGE, F. SEGADE, J. PUNAL, E. OTERO, C. GALBAN, C. PORTELA, J. GASTROAGUDIN

Abstract: 

Introduction.- Fungal infection (FI) is a life-threatening complication in high-risk liver transplant (Tx) recipients. In order to reduce the incidence and morbidity-mortality of this severe complication a prophylaxis protocol with liposomal amphotericin B, AmBisomeTM} has been developed. Material and methods.- Between January-96 and April-98 we prospectively followed 21 patients (pts) of 100 consecutive orthotopic liver trasplantations who were classified as high-risk liver transplant recipients if they fullfilled the following criteria: Fulminant liver failure as indication for Tx (10 pts); assisted ventilation more than 7 days (4 pts); retransplantation (3 pts); relaparotomy (2 pts); antibiotic therapy more than 14 days (6 pts); transfusion requirements more than 20 blood red cells units (6 pts) and biliar leakage (2 pts). These patients received liposomal amphotericin B as prophylaxis at 1 mg/kg/day for 7-10 days. One patient received a course of 22 days. Results.- Follow-up after Tx was 3 months. The global survival of the high risk group was 80% (17/21). The incidence of FI was 9,5% (2/21). No Candida infection was observed. Two patients developed aspergillosis: an abdominal aspergillosis treated with Rx-percutaneous drainage and AmBisomeTM} 5 mg/kg/day had a favourable clinical outcome. One pt. with brain aspergillosis died 25 days after Tx, in spite of the prophylaxis regimen. Adverse events related to liposomal amphotericin B were: hipokalemia (2); back pain (3) and nephrotoxocity (serum creatinine more than 2.5 mg/dl) (2). None of these events required discontinuation of the prophylaxis regimen. Conclusions.- In our study, prophylaxis with AmBisomeTM} in high-risk liver transplant recipients has demonstrated a minimal incidence of adverse events and severe fungal infections. More studies are needed in order to determine the highest risk population and the best dosage of AmBisomeTM} required to reduce the incidence and severity of FI in this group of patients.
1998

abstract No: 

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Full conference title: 

38th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 38th