Prospective Interventional Study to Evaluate the Efficacy and Safety of Liposomal Amphotericin B as Prophylaxis of Fungal Infections in High-Risk Liver Transplant Recipients

2005 ◽  
Vol 37 (9) ◽  
pp. 3965-3967 ◽  
Author(s):  
J.F. Castroagudı́n ◽  
C. Pontón ◽  
M. Bustamante ◽  
E. Otero ◽  
J. Martı́nez ◽  
...  
Keyword(s):  
High Risk ◽  
Liver Transplant ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Efficacy And Safety ◽  
Transplant Recipients ◽  
Interventional Study ◽  
Liver Transplant Recipients

scholarly journals An open study of the comparative efficacy and safety of caspofungin and liposomal amphotericin B in treating invasive fungal infections or febrile neutropenia in patients with haematological malignancy

2006 ◽  
Vol 55 (10) ◽  
pp. 1357-1365 ◽  
Author(s):  
Michael Ellis ◽  
Chris Frampton ◽  
Jose Joseph ◽  
Hussain Alizadeh ◽  
Jorgen Kristensen ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Haematological Malignancy ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Efficacy And Safety ◽  
Significant Independent Predictor

In a clinical non-trial setting, the efficacy and safety of caspofungin was compared with liposomal amphotericin B for the management of febrile neutropenia or invasive fungal infections in 73 episodes in patients with haematological malignancy. There were fewer episodes of drug toxicity with caspofungin than liposomal amphotericin B (58.3 vs 83.7 %, P=0.02). The favourable response rate for episodes of febrile neutropenia treated with caspofungin or liposomal amphotericin B was similar at 37.5 and 53.8 %, respectively, but more breakthrough fungal infections occurred with caspofungin than with liposomal amphotericin B (33.3 vs 0 %, P<0.05) in these patients who did not receive antifungal prophylaxis. None of four episodes of candidaemia or hepatosplenic candidiasis responded to caspofungin compared with three of four episodes treated with liposomal amphotericin B. Mortality was significantly higher with caspofungin treatment compared with liposomal amphotericin B (6/24 vs 2/49, P=0.01), mainly due to an excess of fungal infections (P=0.04). Caspofungin treatment was a significant independent predictor of mortality [odds ratio=7.6 (95 % confidence interval 1.2–45.5)] when sepsis severity, prolonged neutropenia and length of antifungal therapy were considered in a multiple logistic regression model. In clinical practice, there is a suggestion that caspofungin may not be as effective as liposomal amphotericin B in preventing breakthrough invasive fungal infections in febrile neutropenia or in preventing fungus-related deaths. Because of the potential biases in this observational study, these preliminary findings should be interpreted with caution and clarified with a larger cohort of patients.

scholarly journals Isavuconazole and Liposomal Amphotericin B as Successful Combination Therapy of Refractory Invasive Candidiasis in a Liver Transplant Recipient: A Case Report and Literature Review

2021 ◽  
Author(s):  
Georgios Odysseos ◽  
Ulrich Mayr ◽  
Gabor Bozsaki ◽  
Christian Seidensticker ◽  
Ursula Ehmer ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Transplant Recipient ◽  
Liver Transplant ◽  
Amphotericin B ◽  
Invasive Candidiasis ◽  
Liposomal Amphotericin ◽  
Liver Transplant Recipient ◽  
Fungal Infections ◽  
Liposomal Amphotericin B ◽  
High Dose

AbstractInvasive fungal infections in liver transplant recipients are associated with elevated morbidity and mortality and pose a challenge to the treating physicians. Despite of lacking clinical data, the use of antifungal combination therapy is often considered to improve response rates in an immunocompromised patient population. We herein report a case of refractory invasive candidiasis in a liver transplant recipient treated successfully with a combination of isavuconazole und high-dose liposomal amphotericin B. The antimycotic combination treatment was able to clear a bloodstream infection with C. glabrata and led to regression of bilomas among tolerable side effects. The use of the above-mentioned antifungal combination therapy in a liver transplant recipient has not been reported previously. This case highlights the efficacy and safety of antifungal combination therapy in immunocompromised patients with refractory invasive candidiasis.

scholarly journals Observational Study of Associations between Voriconazole Therapeutic Drug Monitoring, Toxicity, and Outcome in Liver Transplant Patients

2017 ◽  
Vol 61 (12) ◽  
Author(s):  
Zahra Hashemizadeh ◽  
Parisa Badiee ◽  
Seyed Ali Malekhoseini ◽  
Hadi Raeisi Shahraki ◽  
Bita Geramizadeh ◽  
...  
Keyword(s):  
Adverse Events ◽  
Liver Transplant ◽  
Fungal Infections ◽  
Therapeutic Drug ◽  
Efficacy And Safety ◽  
Transplant Recipients ◽  
Blood Concentrations ◽  
Trough Concentrations ◽  
Liver Transplant Recipients ◽  
Trough Levels

ABSTRACT The aim of this study was to investigate the variability of the voriconazole plasma level and its relationships with clinical outcomes and adverse events among liver transplant recipients to optimize the efficacy and safety of their treatment. Liver transplant recipients treated with voriconazole were included, and voriconazole trough levels were quantified by a validated high-performance liquid chromatography method. Cytochrome P450 genotypes for CYP2C19 were evaluated in allograft liver tissues. A total of 832 voriconazole trough levels from 104 patients were measured. Proven, probable, and possible invasive fungal infections were reported for 8/104 (7.7%), 42/104 (40.4%), and 54/104 (51.9%) patients, respectively. Receiver operating characteristic (ROC) curve analysis indicated that trough concentrations of ≥1.3 μg/ml minimized the incidence of treatment failure (95% confidence interval [CI], 0.68 to 0.91 μg/ml) (P < 0.001) and that those of <5.3 μg/ml minimized the incidence of any adverse events (95% CI, 0.83 to 0.97 μg/ml) (P < 0.001). Voriconazole trough levels were significantly higher for heterozygous extensive metabolizers, poor metabolizers, and individuals receiving coadministration with proton pump inhibitors. For ultrarapid metabolizers, oral administration of voriconazole, and concomitant use of glucocorticoids, voriconazole blood concentrations were significantly reduced. Furthermore, there was no statistically significant association of patient age, weight, or gender or coadministration of tacrolimus and cyclosporine with the voriconazole trough level. In conclusion, the results of our analysis indicate large inter- and intraindividual variabilities of voriconazole concentrations in liver transplant recipients. Voriconazole trough concentrations of ≥1.3 μg/ml and <5.3 μg/ml are optimal for treatment and for minimization of adverse events. Optimization of drug efficacy and safety requires the use of rational doses for voriconazole therapy.

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