Background: IA after SOT is associated with significant morbidity and mortality. Optimal therapy in this population has not been fully defined. Methods: A 1:4 case:control study, matching for type and time of transplant, was performed to evaluate RF and outcomes for IA in SOT recipients from 10/008722;10/05. Results: Eight cases of IA (3 proven, 2 probable, and 3 possible by EORTC/MSG criteria) and 32 controls were included in the study. IA was disseminated in 2 pts: one with endocarditis, the other with endophthalmitis, both had brain abscesses. In univariate analysis, cases had significantly higher pre-SOT total bilirubin, number of post-SOT infections, and need for post- SOT dialysis. In the table, anti-fungal therapy (AF) is listed in the order of receipt with 5 initially receiving dual AF and all cases receiving V at some point. Doses of V were adjusted based on serum levels. Median duration of AF = 53 d (range 21365+). No pts developed hepatotoxicity. At initiation of V, 5 pts had FK506 dose reduction (DR) by one-half. Mean maximum FK trough in pts with DR= 16.4Â±7.6 ng/mL vs. no DR= 44.1Â±8.3. Two pts developed acute renal failure due to FK toxicity. Seven pts demonstrated at least partial response to AF. Mortality (38% vs 19%) and graft loss (25% vs 13%) did not differ between cases and controls. Conclusion: RF associated with IA include elevated pre-SOT total bilirubin, increased post-SOT infections, and post-SOT dialysis requirement. Supratherapeutic FK levels frequently occur despite FK dose reduction with the initiation of V. Care must be taken in managing FK dosing when starting V therapy for IA wherein reduction of immunosuppression is a critical aspect of treatment. In our limited series, IA associated mortality (38%) is less than that reported in the literature with amphotericin-based therapy (708722;90%).
Full conference title:
Infectious Diseases Society of America, 44th Annual Meeting
- IDSA 44th