Fungus Infections After Liver Transplantation

Schröter, G; Hoelscher, Manfred; Putnam, Charles W.; Porter, Kenneth Wiggins; Starzl, Thomas E.

doi:10.1097/00000658-197707000-00017

Cited by 92 publications

(49 citation statements)

References 13 publications

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“…These figures are similar to those reported in previous analyses of incidence of and mortality from IFI in OLT. [1][2][3][4][5][6] A further analysis of this database showed that the median postoperative ICU stay for the 495 consecutive OLTs performed immediately before the current group was 3 days (range, 0 to 124 days), and that 30% of these transplants required prolonged (Ն5 days) postoperative ICU treatment. The liver transplant recipients in the current study are a similar population in that a similar proportion (30 of 130 patients; 23%) required prolonged ICU treatment and therefore fulfilled the entry criteria for prophylaxis with Abelcet.…”

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%

“…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][2][3][4][5][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.…”

mentioning

confidence: 99%

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Singhal

2000

Liver Transplantation

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“…Cases of invasive aspergillosis have been reported after transplantation of the liver [2][3][4][5][6], kidney [1,[7][8][9][10][11], and heart [12][13][14][15]. Aspergillosis was diagnosed in 9 % of adult liver transplant recipients who received immunosuppressive therapy consisting of administration of azathioprine, prednisone, and antilymphocyte globulin [2].…”

Section: Discussionmentioning

confidence: 99%

“…Aspergillosis was diagnosed in 9 % of adult liver transplant recipients who received immunosuppressive therapy consisting of administration of azathioprine, prednisone, and antilymphocyte globulin [2]. Similarly, 6 % of adult liver transplant recipients treated with cyclosporine and prednisone developed aspergillosis [3,4] .…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, 6 % of adult liver transplant recipients treated with cyclosporine and prednisone developed aspergillosis [3,4] . All patients with aspergillosis from those three series of liver transplantations [2][3][4] [1,[7][8][9][10][11] has survived. Similar survival rates among heart transplant recipients and an occasional survivor of pulmonary disease have been reported, but none of such patients in whom the aspergillosis involved the CNS survived [12][13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

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Aspergillosis of the CNS in a Pediatric Liver Transplant Recipient: Case Report and Review

Green¹,

Wald²,

Tzakis³

et al. 1991

Clinical Infectious Diseases

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Clinical Spectrum of Fungal Infections After Orthotopic Liver Transplantation

Castaldo¹,

Stratta²,

Wood³

et al. 1991

Arch Surg

195

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During a 50-month period, we identified 91 episodes of fungal infection in 72 liver transplant recipients (23.8%). Candida species accounted for 83.5% of cases. Clinical patterns of fungal infections included disseminated infection (19), peritonitis (17), pneumonitis (15), multiple sites of colonization (13), fungemia (11), and other sites (16). The diagnosis of fungal infection was usually made in the first 2 months (84.7% of cases), at a mean time of 16 days after transplantation. Risk factors for fungal infections included retransplantation, Risk score, intraoperative transfusion requirement, urgent status, Roux limb biliary reconstruction (in adults), steroid dose, bacterial infections and antibiotic therapy, and vascular complications. Fungal infections were successfully treated with amphotericin B in 63 cases (74.1%) but were associated with diminished patient survival (50% vs 83.5%). Fungal infection is a frequent source of early morbidity and can be related to well-defined risk factors, suggesting the need for effective prophylaxis.

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Fungus Infections After Liver Transplantation

Cited by 92 publications

References 13 publications

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Aspergillosis of the CNS in a Pediatric Liver Transplant Recipient: Case Report and Review

Clinical Spectrum of Fungal Infections After Orthotopic Liver Transplantation

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