Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome (R)) after liver transplantation

We investigated the prophylactical administration of liposomal amphotericin B (Ambisomc(R)) in the early phase after liver transplantation (LTx). Fift y-eight patients received Ambisome(R) prophylactically after LTx. Ambisome( R) (1 mg kg(-1) day(-1)) was given intravenously for 7 days after LTx. Immu nosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. For ty-seven patients had a tacrolimus-based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150-250 ng ml(-1) (EM IT) and 5-15 ng ml(-1) (MEIA II) respectively. Three patients died from sep sis due to Aspergillus fumigatus infection. Reasons for a fatal outcome wer e foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post-operative day (pod) 8; Aspergillus sepsis with seve re endocardidtis in a patient with two retransplantations for graft non/dys function oil pod 24; and disseminated aspergillosis due to,Aspergillus fumi gatus in a patient retransplanted for primarly non-function (pod 19). All t hree patients underwent haemofiltration for renal failure. One patient with Candida albicans sepsis (pod 4) recovered under increased dosage of Ambiso me(R) (3 mg kg(-1) per day). Ambisome(R) (1 mg kg(-1) per day) seems to be beneficial against systemic Candida infections, However, the onset of syste mic Aspergillus infections could not be prevented. Obviously, higher Ambiso me(R) doses appear to be necessary against Aspergillus. We recommend the us e of Ambisome(R) (3 mg kg(-1) per day) for patients with risk factors such as graft dys-/non-function, retransplantation, haemofiltration and complica ted acute liver failure to prevent invasive aspergillosis.