Weekly high-dose liposomal amphotericin B prevents invasive aspergillosis after heart transplantation.
heart transplantation
invasive aspergillosis
liposomal amphotericin B
prophylaxis
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
revised:
07
09
2021
received:
30
06
2021
accepted:
29
09
2021
pubmed:
18
10
2021
medline:
25
12
2021
entrez:
17
10
2021
Statut:
ppublish
Résumé
Preventive strategies for invasive aspergillosis (IA) have still not been determined in heart transplant recipients whereas IA leads to a high mortality rate at 12 months posttransplantation. The use of voriconazole or echinocandins was proposed but can favor emergence of Aspergillus or Candida sp. resistant strains or promote neurological and liver disorders in some patients. To assess whether universal prophylaxis with weekly high-dose of liposomal amphotericin-B (L-AmB) can safely prevent IA in heart transplant recipients. Retrospective before/after study that included 142 patients who received heart transplantation between 2010 and 2019 at the University Hospital of Toulouse (France). Weekly high dose of L-AmB (7.5 mg/kg/week) was used as universal prophylaxis from 2016 because of high environmental exposure to Aspergillus sp. and high incidence of IA. Cumulative 1-year incidence of IA decreased from 23% to 5% after introduction of L-Amb prophylaxis. Multivariate analysis (Cox model) identified L-AmB prophylaxis as a protective factor against IA (hazard ratio [HR] 0.21 [95% confidence interval 0; 0.92], p = .04), whereas postoperative renal replacement therapy was associated with IA (HR 3.6 [95% confidence interval 1.38; 9.3], p = .001), after correction for confounding effects (induction regimen, methylprednisolone pulses and history of hematological malignancy). The incidence of acute kidney injury requiring renal replacement therapy was similar in the two groups, suggesting a low risk of kidney toxicity when L-AmB is used weekly. No patient developed severe kidney electrolyte loss nor L-AmB-related anaphylaxis. Once-weekly high-dose L-AmB is safe and may prevent the development of IA after heart transplantation.
Sections du résumé
BACKGROUND
BACKGROUND
Preventive strategies for invasive aspergillosis (IA) have still not been determined in heart transplant recipients whereas IA leads to a high mortality rate at 12 months posttransplantation. The use of voriconazole or echinocandins was proposed but can favor emergence of Aspergillus or Candida sp. resistant strains or promote neurological and liver disorders in some patients.
OBJECTIVES
OBJECTIVE
To assess whether universal prophylaxis with weekly high-dose of liposomal amphotericin-B (L-AmB) can safely prevent IA in heart transplant recipients.
PATIENTS/METHODS
METHODS
Retrospective before/after study that included 142 patients who received heart transplantation between 2010 and 2019 at the University Hospital of Toulouse (France). Weekly high dose of L-AmB (7.5 mg/kg/week) was used as universal prophylaxis from 2016 because of high environmental exposure to Aspergillus sp. and high incidence of IA.
RESULTS
RESULTS
Cumulative 1-year incidence of IA decreased from 23% to 5% after introduction of L-Amb prophylaxis. Multivariate analysis (Cox model) identified L-AmB prophylaxis as a protective factor against IA (hazard ratio [HR] 0.21 [95% confidence interval 0; 0.92], p = .04), whereas postoperative renal replacement therapy was associated with IA (HR 3.6 [95% confidence interval 1.38; 9.3], p = .001), after correction for confounding effects (induction regimen, methylprednisolone pulses and history of hematological malignancy). The incidence of acute kidney injury requiring renal replacement therapy was similar in the two groups, suggesting a low risk of kidney toxicity when L-AmB is used weekly. No patient developed severe kidney electrolyte loss nor L-AmB-related anaphylaxis.
CONCLUSIONS
CONCLUSIONS
Once-weekly high-dose L-AmB is safe and may prevent the development of IA after heart transplantation.
Substances chimiques
Antifungal Agents
0
liposomal amphotericin B
0
Amphotericin B
7XU7A7DROE
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13745Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
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Neofytos D, Chatzis O, Nasioudis D, et al. Epidemiology, risk factors and outcomes of invasive aspergillosis in solid organ transplant recipients in the Swiss Transplant Cohort Study. Transpl Infect Dis. 2018;20(4):e12898. https://doi.org/10.1111/tid.12898
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Coste AT, Kritikos A, Li J, et al. Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland. Infection. 2020;48(5):761-766. https://doi.org/10.1007/s15010-020-01475-8
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Chaftari AM, Hachem RY, Ramos E, et al. Comparison of posaconazole versus weekly amphotericin B lipid complex for the prevention of invasive fungal infections in hematopoietic stem-cell transplantation. Transplantation. 2012;94(3):302-308. https://doi.org/10.1097/TP.0b013e3182577485
Giannella M, Ercolani G, Cristini F, et al. High-dose weekly liposomal amphotericin B antifungal prophylaxis in patients undergoing liver transplantation: A prospective phase II trial. Transplantation. 2015;99(4):848-854. https://doi.org/10.1097/TP.0000000000000393