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

Background, Posttransplant renal replacement therapy has been shown to be a n independently significant risk factor for invasive fungal infections afte r liver transplantation. We assessed the efficacy of a lipid preparation of amphotericin B as prophylaxis for invasive fungal infections, directed tow ard liver transplant recipients requiring renal replacement therapy. Methods. A total of 148 patients transplanted between 1990 and 1997 receive d no antifungal prophylaxis, Since 1997, 38 patients underwent liver transp lantation; antifungal prophylaxis with a lipid preparation of amphotericin B was used in patients requiring renal replacement therapy, Results, Fifteen percent (22 of 148) of the patients transplanted before 19 97 required renal replacement therapy. In this cohort, the incidence of inv asive fungal infections (36% vs. 7%, P=0.0007) and invasive aspergillosis ( 14% vs. 2%, P=0.02) was significantly higher in patients who required renal replacement therapy compared with those who did not. Since 1997, 29% (11 o f 38) of the patients required renal replacement therapy and received antif ungal prophylaxis, Invasive fungal infections occurred in 36% (8 of 22) of the patients who received no prophylaxis (patients before 1997), and 0% (9 of 11, P=0.03) in those who received antifungal prophylaxis (since 1997), A ntifungal prophylaxis was independently associated with protection from fun gal infection (P=0.017). No reduction in mortality with antifungal prophyla xis was documented, Conclusion, Prophylaxis with a lipid preparation of amphotericin B was asso ciated with a significant reduction in invasive fungal infections in high-r isk liver transplant recipients, i.e., those requiring renal replacement th erapy, However, no beneficial effect on survival could be documented.