title: Role of liposomal amphotericin B prophylaxis after liver transplantation compared with fluconazole for high-risk patients. impact on infections and mortality within one year.
abstract: BACKGROUND
  Fungal infections are still one of the most important issue in liver transplant patients, contributing considerably to both morbidity and mortality. Few studies have been published comparing antifungal protocols for their impact on liver transplant (OLT) patients. The aim of this study was to evaluate the effects of liposomal amphotericin B compared with fluconazole prophylaxis on morbidity and mortality after liver transplantation.
  
  
  METHODS
  We evaluated all 44 patients undergoing OLT from January 2006 to January 2009 who were enrolled and randomized to undergo treatment with Amphotericin B (3 mg/kg/d; group A = 25 patients) or fluconazole (800 mg Loading dose and thereafter 400 mg/d according to renal parameters and immunosuppressant trough levels; group B = 18 patients) for at least 7 to 14 days with 12 months follow-up after liver transplantation. A multivariate analysis assessed factors associated with infections and mortality.
  
  
  RESULTS
  Neither antifungal prophylaxis was associated with a fungal episode; however, group A patients experienced fewer bacterial infectious episodes (Mann-Whitney U test P < .05). Furthermore, no renal impairment was observed in either groups. Nonetheless, patients undergoing fluconazole prophylaxis showed significant increases in immunosuppressive trough levels requiring dose adjustment.
  
  
  CONCLUSIONS
  We observed comparable results of fluconazole and liposomal amphotericin B to prevent invasive fungal infections throughout 12 months after surgery. The latter drug was associated with fewer bacterial infections after liver transplantation.
authors.affiliation: Laparoscopic, Hepatic and Liver Transplant Unit, AORN A. Cardarelli, Naples, Italy; VII Department of Infectious Disease and Immunology, AORN Monaldi-Cotugno-CTO, Naples, Italy. alessandroperrella@fastwebnet.it
authors.forename: A
authors.initials: A
authors.lastname: Perrella
authors.forename: C
authors.initials: C
authors.lastname: Esposito
authors.forename: D
authors.initials: D
authors.lastname: Pisaniello
authors.forename: L
authors.initials: L
authors.lastname: D'Alessio
authors.forename: O
authors.initials: O
authors.lastname: Perrella
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.forename: O
authors.initials: O
authors.lastname: Cuomo
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology*; D000935:Antifungal Agents / Q000494:pharmacology*; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation; D015999:Multivariate Analysis
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B