title: Prospective interventional study to evaluate the efficacy and safety of liposomal amphotericin B as prophylaxis of fungal infections in high-risk liver transplant recipients.
abstract: BACKGROUND
  Invasive fungal infections are a life-threatening complication in transplant recipients. The prevalence of fungal infection after orthotopic liver transplantation (OLT) is 5% to 42%. The most common isolated pathogens are Candida and Aspergillus species. High-risk liver transplant recipients are more susceptible to the development of invasive fungal infections, with prevalence >40% and mortality rates of 78% to 100%. The strategy for fungal prophylaxis in this population has not been defined.
  
  
  METHODS
  Among 100 consecutive OLT followed for 28 months, 21 recipients (15 men, overall mean age of 48.5 years, range 23-65 years) were considered to be high risk for the development of fungal infections when they presented at least one of the following criteria: acute liver failure, assisted ventilation >7 days, retransplantation, relaparotomy, antibiotic therapy >14 days, transfusion requirements >20 red blood cells units, and/or biliary leakage. This group received intravenous liposomal amphotericin B (1 mg/kg/d for 7-10 days).
  
  
  RESULTS
  One-year survival in the high-risk group was 80%. Prevalence of invasive fungal infection was 9.5%. No Candida infection was observed. Two patients developed Aspergillus infection: an abdominal aspergillosis treated with percutaneous drainage and liposomal amphotericin B (5 mg/kg/d) showed a favorable clinical outcome. The other patient who developed brain aspergillosis died 25 days after OLT. Adverse events related to the drug were hypokalemia (n = 2), back pain (n = 3), and renal dysfunction (n = 2). None of these events required withdrawal of the prophylaxis regimen.
  
  
  CONCLUSIONS
  In our series, prophylaxis with liposomal amphotericin B in high-risk liver graft recipients showed a low rate of severe fungal infections. More studies are needed in order to determine the highest risk population and the best drug dosage.
authors.affiliation: Liver Transplantation Unit, University Hospital, Santiago de Compostela, Spain. javier.fernandez.castroagudin@sergas.es
authors.forename: J F
authors.initials: JF
authors.lastname: Castroagudín
authors.forename: C
authors.initials: C
authors.lastname: Pontón
authors.forename: M
authors.initials: M
authors.lastname: Bustamante
authors.forename: E
authors.initials: E
authors.lastname: Otero
authors.forename: J
authors.initials: J
authors.lastname: Martínez
authors.forename: S
authors.initials: S
authors.lastname: Tomé
authors.forename: R
authors.initials: R
authors.lastname: Conde
authors.forename: F R
authors.initials: FR
authors.lastname: Segade
authors.forename: M
authors.initials: M
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Brage
authors.forename: C
authors.initials: C
authors.lastname: Galbán
authors.forename: E
authors.initials: E
authors.lastname: Varo
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D004198:Disease Susceptibility; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D009181:Mycoses / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B