Fungal infection and liposomal amphotericin B (AmBisome) therapy in liver transplantation: a 2 year review

Fisher, Neil; Singhal, Saurabh; Miller, Sharon; Hastings, James; Mutimer, David

doi:10.1093/jac/43.4.597

Cited by 28 publications

(27 citation statements)

References 11 publications

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“…Postmortem studies of liver transplant recipients have shown that IFI is often cryptic during life, and that invasive disseminated infection with Aspergillus species is frequently persistent despite prolonged HD therapy with amphotericin B. 2,6,8,26,27,30,31 We recently reviewed our use of AmBisome in 30 patients post-OLT. 31 Of 5 patients administered AmBisome (median dosage, 3.2 mg/k/d; range, 2.8 to 3.5 mg/kg/d for a median of 14 days; range, 6 to 20 days) for presumed invasive aspergillosis, 4 patients died.…”

Section: Discussionmentioning

confidence: 99%

“…2,6,8,26,27,30,31 We recently reviewed our use of AmBisome in 30 patients post-OLT. 31 Of 5 patients administered AmBisome (median dosage, 3.2 mg/k/d; range, 2.8 to 3.5 mg/kg/d for a median of 14 days; range, 6 to 20 days) for presumed invasive aspergillosis, 4 patients died. Postmortem examination was performed in 3 of these 4 patients, and invasive aspergillosis was confirmed in each case.…”

Section: Discussionmentioning

confidence: 99%

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Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Singhal

2000

Liver Transplantation

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The purpose of this study is to prospectively evaluate a strategy in which prophylaxis with amphotericin B lipid complex at 3 different dosages was targeted to liver transplant recipients at high risk for the development of invasive fungal infection (IFI). High risk was defined as a postoperative requirement for prolonged (>5 days) intensive care unit (ICU) treatment. Consecutive high-risk patients were administered prophylaxis with amphotericin B lipid complex from day 5 after orthotopic liver transplantation (OLT) until ICU discharge or death. The first 10 eligible patients were administered 5 mg/kg/d, the next 10 patients were administered 2. I nvasive fungal infection (IFI) has a high mortality after orthotopic liver transplantation (OLT). In early studies, the incidence of IFI in this setting ranged from 18% to 42%, and the associated mortality rates were 50% to 78%. 1-6 Candida species accounted for the majority of infections, and many patients infected with Candida organisms survived. In contrast, infections caused by Aspergillus species were nearly always fatal. 2,3,6 We showed that in liver transplant recipients considered high risk for IFI, fluconazole prophylaxis reduced the incidence of invasive candidiasis 7 but was complicated by the emergence of fluconazole-resistant fungi and failed to prevent invasive aspergillosis. 8 A recent randomized, placebo-controlled trial of liver transplant recipients showed that prophylaxis with fluconazole was associated with a decrease in fungal colonization and fewer deaths related to IFI, but did not improve overall survival. 9 Amphotericin B formulations are the agents of choice for the treatment of infections caused by Aspergillus species. Concerns about toxicity related to conventional amphotericin B 10 have inhibited its use as antifungal prophylaxis in OLT. The development of new lipid-based formulations of amphotericin B that are less toxic than the conventional form of the drug has led to renewed interest in the potential prophylactic use of this agent. [11][12][13][14] In 1 study, prophylaxis with liposomal amphotericin B (AmBisome; Nexstar, San Dimas, CA) at 1 mg/kg/d from the time of OLT reduced the incidence of IFI compared with placebo. 15 However, another group observed systemic mycosis in 4 of 58 liver transplant recipients treated according to a similar prophylactic schedule with AmBisome. 16 Amphotericin B lipid complex (Abelcet; The Liposome Co Ltd, London, England) is a lipid formulation with a high amphotericin B-lipid ratio (1:1), 17 and pharmacokinetic studies indicate that this formulation achieves lower peak plasma concentrations but greater tissue levels than the other lipid formulations of amphotericin B. 18 Furthermore, the in vitro activity of Abelcet against isolates of both Aspergillus and Candida organisms has recently been shown to be similar to that achieved by conventional amphotericin B but significantly greater than that achieved by AmBisome. 19 A randomized, prospective multicenter trial confirmed that Abelcet was as effective as...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Singhal

2000

Liver Transplantation

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“…Segundo Fisher et al (1999), seis destes pacientes com insuficiência renal e respiratória morreram e a análise tecidual post-mortem revelou Aspergillus spp. em 3 dos casos.…”

Section: Estudos Em Humanosunclassified

Eficiência terapêutica das formulações lipídicas de anfotericina B

Filippin

Souza

2006

Rev. Bras. Cienc. Farm.

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“…간이식수술 후 이식거부 반응을 막기 위해 모든 환자에서 면역억제 제를 광범위하게 사용하기 때문에 이식수술 후에는 면역 력이 낮아져 진균 감염의 가능성이 수술 전보다 높아지 게 된다 (6)(7)(8). 간이식수술을 받은 환자에게 있어서 진균 감염에 대한 치료 및 예방은 매우 중요하다 (9). 간이식 후 침습성 아스페르길루스증의 유병률은 약 1.5%로 알려져 있다 (4,(10)(11)(12).…”

Section: 서 론unclassified