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Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome ® ) after liver transplantation
Author(s) -
Lorf T.,
Braun F.,
Rüchel R.,
Müller A.,
Sattler B.,
Ringe B.
Publication year - 1999
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1046/j.1439-0507.1999.00266.x
Subject(s) - medicine , aspergillosis , aspergillus fumigatus , gastroenterology , transplantation , amphotericin b , sepsis , liver transplantation , surgery , immunology , antifungal , dermatology
We investigated the prophylactical administration of liposomal amphotericin B (Ambisome ® ) in the early phase after liver transplantation (LTx). Fifty‐eight patients received Ambisome ® prophylactically after LTx. Ambisome ® (1 mg kg −1 day −1 ) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty‐seven patients had a tacrolimus‐based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150–250 ng ml −1 (EMIT) and 5–15 ng ml −1 (MEIA II) respectively. Three patients died from sepsis due to Aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post‐operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non‐/dysfunction on pod 24; and disseminated aspergillosis due to Aspergillus fumigatus in a patient retransplanted for primary non‐function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with Candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome ® (3 mg kg −1 per day). Ambisome ® (1 mg kg −1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome ® doses appear to be necessary against Aspergillus . We recommend the use of Ambisome ® (3 mg kg −1 per day) for patients with risk factors such as graft dys‐/non‐function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.