Combination antifungal therapy for invasive aspergillosis infection in liver transplant recipients: Report of two patients

Invasive aspergillosis in solid organ transplant recipients is associated w ith mortality of approximately 100%. The search for optimal therapy has led clinicians to administer antifungal combinations. Two orthotopic liver tra nsplant recipients developed invasive aspergillosis (pulmonary and perivert ebral) after transplantation and were treated with combination antifungal t herapy consisting of liposomal amphotericin B and itraconazole. Although bo th patients were initially stabilized, they died after 94 and 138 days of a ntifungal therapy, respectively. Presumably, aspergillosis was the principa l cause of death. Antifungal serum concentrations and fungicidal titers in both patients indicated that the drugs may have been antagonistic and thus detrimental.