Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis.
BACKGROUND
Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known.


METHODS
We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis.


RESULTS
Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline (P = .94 ). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors (P = .034), renal failure at baseline (P = .016), and fungemia (P = .003) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality (P = .007). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine (P = .349). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; P = .047) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; P = .004 ) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; P = .008).


CONCLUSIONS
Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.
Sun
Hsin-Yun
HY
VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Alexander
Barbara D
BD
Lortholary
Olivier
O
Dromer
Francoise
F
Forrest
Graeme N
GN
Lyon
G Marshall
GM
Somani
Jyoti
J
Gupta
Krishan L
KL
del Busto
Ramon
R
Pruett
Timothy L
TL
Sifri
Costi D
CD
Limaye
Ajit P
AP
John
George T
GT
Klintmalm
Goran B
GB
Pursell
Kenneth
K
Stosor
Valentina
V
Morris
Michelle I
MI
Dowdy
Lorraine A
LA
Munoz
Patricia
P
Kalil
Andre C
AC
Garcia-Diaz
Julia
J
Orloff
Susan
S
House
Andrew A
AA
Houston
Sally
S
Wray
Dannah
D
Huprikar
Shirish
S
Johnson
Leonard B
LB
Humar
Atul
A
Razonable
Raymund R
RR
Husain
Shahid
S
Singh
Nina
N
D000328:Adult; D000666:Amphotericin B / Q000737:chemistry* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000737:chemistry / Q000627:therapeutic use; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000382:microbiology; D003453:Cryptococcosis / Q000188:drug therapy*; D004339:Drug Compounding; D005260:Female; D006801:Humans; D008055:Lipids / Q000737:chemistry*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019737:Transplants; D016896:Treatment Outcome
D000935:Antifungal Agents; D008055:Lipids; D000666:Amphotericin B