Feasibility, tolerability, and outcomes of nebulized liposomal amphotericin B for Aspergillus infection prevention in lung transplantation.

Abstract

BACKGROUND:

Nebulized amphotericin B deoxycholate (n-ABD) is used to prevent Aspergillus infection in lung transplantation. Nebulized liposomal amphotericin B (n-LAB) is another option; however, no clinical data are available on the results of n-LAB for this purpose.

METHODS:

In an observational study performed in 2 centers to assess the feasibility, tolerability, and outcomes of n-LAB prophylaxis, 104 consecutive patients undergoing prophylaxis with n-LAB were compared with 49 historical controls who received n-ABD. Patient follow-up lasted 12 months. The n-LAB prophylaxis regimen was 25 mg thrice weekly starting on the first post-operative day and continuing to 60 days, 25 mg once weekly from 60 to 180 days, and the same dose once every 2 weeks thereafter.

RESULTS:

Aspergillus infection developed in 8 of 104 patients (7.7%) with n-LAB prophylaxis (5 colonization, 1 simple tracheobronchitis, 1 ulcerative tracheobronchitis, and 1 invasive pulmonary infection). Ulcerative tracheobronchitis and invasive pulmonary aspergillosis were regarded as invasive disease; hence, the rate of invasive disease was 1.9% (2 patients). The control group had similar rates of Aspergillus infection (10.2%; p = 0.6) and invasive disease (4.1%; p = 0.43). In 3 patients (2.9%), n-LAB was withdrawn due to bronchospasm in 2 and nausea in 1. In the control group, prophylaxis was stopped in 2 patients (4.1%) because of bronchospasm (p = 0.7).

CONCLUSIONS:

At the dose and frequency described, n-LAB seems effective, safe, and convenient for the prevention of Aspergillus infection in lung transplant patients.

• Authors: Víctor Monforte, Piedad Ussetti, Joan Gavaldà, Carles Bravo, Rosalia Laporta, Oscar Len, Cristina López García-Gallo, Lluís Tenorio, Joan Solé, Antonio Román
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 29 Issue 5 Pg. 523-30 (May 2010) ISSN: 1557-3117 [Electronic] United States
• PMID: 20061165 (Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study)
• Copyright: Copyright (c) 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antifungal Agents
• Drug Combinations
• Immunosuppressive Agents
• Liposomes
• Deoxycholic Acid
• Amphotericin B
• amphotericin B, deoxycholate drug combination

Topics

• Administration, Inhalation
• Adult
• Amphotericin B (administration & dosage, adverse effects)
• Antifungal Agents (administration & dosage, adverse effects)
• Cohort Studies
• Deoxycholic Acid (administration & dosage, adverse effects)
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Drug Combinations
• Drug Therapy, Combination
• Feasibility Studies
• Female
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Liposomes
• Lung Transplantation (immunology)
• Male
• Middle Aged
• Opportunistic Infections (prevention & control)
• Pulmonary Aspergillosis (prevention & control)