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.
Full conference title:
38th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 38th