Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis.

Abstract

BACKGROUND:

Whether outcome of central nervous system (CNS) cryptococcosis in solid organ transplant recipients treated with lipid formulations of amphotericin B is different from the outcome of the condition treated with amphotericin B deoxycholate (AmBd) is not known.

METHODS:

We performed a multicenter study involving a cohort comprising consecutive solid organ transplant recipients with CNS cryptococcosis.

RESULTS:

Of 75 patients treated with polyenes as induction regimens, 55 (73.3%) received lipid formulations of amphotericin B and 20 (26.7%) received AmBd. Similar proportions of patients in both groups had renal failure at baseline (P = .94 ). Overall, mortality at 90 days was 10.9% in the group that received lipid formulations of amphotericin B and 40.0% in the group that received AmBd. In univariate analysis, nonreceipt of calcineurin inhibitors (P = .034), renal failure at baseline (P = .016), and fungemia (P = .003) were significantly associated with mortality. Compared with AmBd, lipid formulations of amphotericin B were associated with a lower mortality (P = .007). Mortality did not differ between patients receiving lipid formulations of amphotericin B with or without flucytosine (P = .349). In stepwise logistic regression analysis, renal failure at baseline (odds ratio [OR], 4.61; 95% confidence interval [CI], 1.02-20.80; P = .047) and fungemia (OR, 10.66; 95% CI, 2.08-54.55; P = .004 ) were associated with an increased mortality, whereas lipid formulations of amphotericin B were associated with a lower mortality (OR, 0.11; 95% CI, 0.02-0.57; P = .008).

CONCLUSIONS:

Lipid formulations of amphotericin B were independently associated with better outcome and may be considered as the first-line treatment for CNS cryptococcosis in these patients.

• Authors: Hsin-Yun Sun, Barbara D Alexander, Olivier Lortholary, Francoise Dromer, Graeme N Forrest, G Marshall Lyon, Jyoti Somani, Krishan L Gupta, Ramon del Busto, Timothy L Pruett, Costi D Sifri, Ajit P Limaye, George T John, Goran B Klintmalm, Kenneth Pursell, Valentina Stosor, Michelle I Morris, Lorraine A Dowdy, Patricia Munoz, Andre C Kalil, Julia Garcia-Diaz, Susan Orloff, Andrew A House, Sally Houston, Dannah Wray, Shirish Huprikar, Leonard B Johnson, Atul Humar, Raymund R Razonable, Shahid Husain, Nina Singh
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 49 Issue 11 Pg. 1721-8 (Dec 01 2009) ISSN: 1537-6591 [Electronic] United States
• PMID: 19886800 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antifungal Agents
• Lipids
• Amphotericin B

Topics

• Adult
• Amphotericin B (chemistry, therapeutic use)
• Antifungal Agents (chemistry, therapeutic use)
• Central Nervous System Diseases (drug therapy, microbiology)
• Cryptococcosis (drug therapy)
• Drug Compounding
• Female
• Humans
• Lipids (chemistry)
• Male
• Middle Aged
• Prospective Studies
• Transplants
• Treatment Outcome