title: Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis.
abstract: 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.
authors.affiliation: VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Sun
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Alexander
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Francoise
authors.initials: F
authors.lastname: Dromer
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: G Marshall
authors.initials: GM
authors.lastname: Lyon
authors.forename: Jyoti
authors.initials: J
authors.lastname: Somani
authors.forename: Krishan L
authors.initials: KL
authors.lastname: Gupta
authors.forename: Ramon
authors.initials: R
authors.lastname: del Busto
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: George T
authors.initials: GT
authors.lastname: John
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pursell
authors.forename: Valentina
authors.initials: V
authors.lastname: Stosor
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Morris
authors.forename: Lorraine A
authors.initials: LA
authors.lastname: Dowdy
authors.forename: Patricia
authors.initials: P
authors.lastname: Munoz
authors.forename: Andre C
authors.initials: AC
authors.lastname: Kalil
authors.forename: Julia
authors.initials: J
authors.lastname: Garcia-Diaz
authors.forename: Susan
authors.initials: S
authors.lastname: Orloff
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Sally
authors.initials: S
authors.lastname: Houston
authors.forename: Dannah
authors.initials: D
authors.lastname: Wray
authors.forename: Shirish
authors.initials: S
authors.lastname: Huprikar
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Johnson
authors.forename: Atul
authors.initials: A
authors.lastname: Humar
authors.forename: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: 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
chemical_list: D000935:Antifungal Agents; D008055:Lipids; D000666:Amphotericin B