Surveillance and treatment of liver transplant recipients for candidiasis and aspergillosis.
Between June 1988 and May 1991 88 orthotopic liver transplants and 1 liver and pancreas transplant were performed at the Liver Transplantation Department of the Ospedale Maggiore of Milan. All the patients underwent mycological surveillance and received antifungal prophylaxis with oral amphotericin B (6000 mg/day) or oral or intravenous fluconazole (200 mg/day) from the time of their transplant. The incidence of Candida colonization was 67%. Fluconazole was superior to oral amphotericin B in the treatment of C. albicans colonization (9/9 vs 6/15), but less effective in the treatment of colonization by other Candida spp. (0/3 vs 3/3). Deep-seated candidiasis developed in 5 patients, caused by C. albicans in 4 cases and C. krusei in 1. C. albicans infection resolved rapidly with fluconazole in 2 subjects, with intravenous amphotericin B alone in 1, and with amphotericin B plus flucytosine in the other. On the contrary, C. krusei infection did not respond to treatment with amphotericin B combined with flucytosine. Aspergillosis was diagnosed in 11 patients, of whom 4 died from invasive aspergillosis, despite 15 and 26 days of amphotericin B treatment in 2. In another patient invasive aspergillosis, diagnosed a few hours before retransplantation, improved with liposomal amphotericin B, but this man died from cytomegalovirus infection one month later. Aspergillosis was eradicated by itraconazole in 4 other patients and by topical amphotericin B in 2 whose infection was localized to surgical wound.
Viviani
M A
MA
Istituto di Igiene e Medicina Preventiva, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Italy.
Tortorano
A M
AM
Malaspina
C
C
Colledan
M
M
Paone
G
G
Rossi
G
G
Bordone
G
G
Pagano
A
A
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000517:prevention & control; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011292:Premedication
D000666:Amphotericin B; D015725:Fluconazole