Invasive aspergillosis in liver transplant recipients: association with candidemia and consumption coagulopathy and failure of prophylaxis with low-dose amphotericin B.
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.
Singh
N
N
Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240.
Mieles
L
L
Yu
V L
VL
Gayowski
T
T
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
D000666:Amphotericin B