title: Invasive aspergillosis in liver transplant recipients: association with candidemia and consumption coagulopathy and failure of prophylaxis with low-dose amphotericin B.
abstract: Invasive aspergillosis developed in three (5%) of 55 adult liver transplant recipients at our institution. All three of our patients had concomitant candidemia and consumption coagulopathy, and invasive aspergillosis developed while they were receiving therapy with intravenous amphotericin B (0.5 mg/[kg.d]). The simultaneous occurrence of candidemia and invasive aspergillosis in liver transplant recipients may reflect a common defect in the host-defense mechanism against Candida and Aspergillus organisms (i.e., impaired phagocytic and mononuclear macrophage function) and liver disease per se. These three cases suggest that such low-dose intravenous amphotericin B will likely be ineffective if used as antifungal prophylaxis for invasive aspergillosis.
authors.affiliation: Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240.
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: L
authors.initials: L
authors.lastname: Mieles
authors.forename: V L
authors.initials: VL
authors.lastname: Yu
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000494:pharmacology; D001228:Aspergillosis / Q000209:etiology* / Q000517:prevention & control; D002177:Candidiasis / Q000209:etiology; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D016469:Fungemia / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
chemical_list: D000666:Amphotericin B