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Preemptive prophylaxis with a lipid preparation of amphotericin B for invasive fungal infections in liver transplant recipients



Preemptive prophylaxis with a lipid preparation of amphotericin B for invasive fungal infections in liver transplant recipients



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 42: 315



Background: Invasive fungal infections (IFI) are associated with a high mortality in liver transplant recipients (LTR). Different variables have been identified as risk factor of IFI in these patients. Methods: A retrospective study to evaluate the efficacy of IFI prevention with lipidic amphotericin B (AmBisome or Abelcet)(LAmB) in LTR after transplantation was performed. Following variables occurred within the first two weeks after transplantation were considered: Requirement of blood products (>30), dialysis, renal failure (creat >2 mg/dl), retransplantation, reoperation, CMV antigenemia (>10 positive cells), acute rejection, fungal colonization, antibiotherapy (>5 days) and previous ICU stay. Since 1998 patients who fulfilled gtoreq4 variables received LAmB (cumulate dose: 1-2 grs). A comparative study analyzing IFI incidence between the historic patients (HG) and prophylacted patients (PG) was performed. Results: 280 LTR were analyzed during a period of 8 years. In HG IFI were observed in 22/129 pts (17%): invasive aspergillosis (IA) in 14 pts (11%) and invasive candidasis(ICA) in 6 pts (8%). In the 28 pts in HG with gtoreq4 variables. 15 pts (53%) developed IFI. Since 1998, prophylactic strategy was applied and IFI was observed in only 7/144 (5%); IA in 6 pts and ICA in 1 pts. LamB was administered to 18 pts (12 of them with gtoreq4 variables) and 1 pt developed IFI (IA); in the other 126 pts LamB was not administered (included 18 pts with gtoreq4 variables) and 6 pts developed IFI (5 IA, developed in days +30, +45, +71, +120 and +120) and 1 ICA (in day +16) (p=NS). Conclusions: Risk factors for IFI in LTR are well identified. The introduction of prophylaxis with LamB based in these risk factors has been followed by a decrease in IFI incidence although it is not directly related. Other strategies could be added to prevent IFI, mainly in cases of late infections.

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Accession: 035538285

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