title: Prophylactic use of liposomal amphotericin B in preventing fungal infections early after liver transplantation: a retrospective, single-center study.
abstract: In this study the authors evaluated the efficacy of prophylaxis with liposomal amphotericin B (L-AmB) in the incidence of fungal infections (FI) during the first 3 months after liver transplant (LT). The study was retrospective and accessed a 4-year period from 2008 to 2011. All patients who died in the first 48 hours after LT were excluded. Patients were divided by the risk groups for FI: Group 1, high-risk (at least 1 of the following conditions: urgent LT; serum creatinine >2 mg/dL; early acute kidney injury [AKI] after LT; retransplantation; surgical exploration early post-LT; transfused cellular blood components [>40 U]); and Group 2, low-risk patients. Group 1 patients were further separated into those who received antifungal prophylaxis with L-AmB and those who did not. Prophylaxis with L-AmB consisted of intravenous administration of L-AmB, 100 mg daily for 14 days. Four hundred ninety-two patients underwent LT; 31 died in the first 48 hours after LT. From the remaining 461 patients, 104 presented with high-risk factors for FI (Group 1); of these, 66 patients received antifungal prophylaxis and 38 did not. In this group 8 FI were observed, 5 in patients without antifungal prophylaxis (P = .011). Three more FI were identified in Group 2. By logistic regression analysis, the categorical variable high-risk group was independently related to the occurrence of invasive FI (P = .006). We conclude that prophylaxis with L-AmB after LT was effective in reducing the incidence of FI. No influence on mortality was detected.
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: A M
authors.initials: AM
authors.lastname: Antunes
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Teixeira
authors.affiliation: Instituto de Investigação do Medicamento, Faculdade de Farmácia, Universidade de Lisboa, Portugal.
authors.forename: M L
authors.initials: ML
authors.lastname: Corvo
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Perdigoto
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Barroso
authors.affiliation: Liver Transplantation Unit, Hospital Curry Cabral, Lisbon, Portugal. Electronic address: p.marcelino@netcabo.pt.
authors.forename: P
authors.initials: P
authors.lastname: Marcelino
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000517:prevention & control*; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B