title: Invasive aspergillosis in liver transplant recipients: outcome comparison of therapy with amphotericin B lipid complex and a historical cohort treated with conventional amphotericin B.
abstract: Invasive aspergillosis (IA) in liver transplant recipients is associated with poor response rates and a very high mortality rate, despite administration of therapy with conventional amphotericin B. We conducted a single-center, retrospective study to compare the outcome of liver transplant recipients with IA who received amphotericin B lipid complex (ABLC) or conventional amphotericin B. IA was present in 12 ABLC-treated patients (definite, 4; probable, 8) and 29 amphotericin B recipients (definite, 11; probable, 18) in the historical cohort. The 60-day mortality rate was lower in the ABLC cohort: 4 (33%) of 12 patients versus 24 (83%) of 29 patients (P=.006). Only 1 of 4 ABLC recipients with definite IA died, compared with all 11 in the amphotericin B group. Sixty-day survival probability curves was significantly lower in the amphotericin B cohort (P=.008). ABLC therapy was the only independent mortality-protective variable (odds ratio, 0.31; 95% confidence interval, 0.07-0.44; P=.02). First-line or early salvage therapy for IA with ABLC was associated with significantly improved survival relative to a comparable historical group treated with amphotericin B.
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, 15261, USA. lindenpk@ccm.upmc.edu
authors.forename: Peter K
authors.initials: PK
authors.lastname: Linden
authors.forename: Kim
authors.initials: K
authors.lastname: Coley
authors.forename: Paolo
authors.initials: P
authors.lastname: Fontes
authors.forename: John J
authors.initials: JJ
authors.lastname: Fung
authors.forename: Shimon
authors.initials: S
authors.lastname: Kusne
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000401:mortality; D002626:Chemistry, Pharmaceutical; D004337:Drug Carriers; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008055:Lipids; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D004337:Drug Carriers; D008055:Lipids; D000666:Amphotericin B