Lipid Formulations of Amphotericin B Significantly Improve Outcome in Solid Organ Transplant Recipients with Central Nervous System Cryptococcosis Article

Full Text via DOI: 10.1086/647948 PMID: 19886800 Web of Science: 000271505200015
International Collaboration

Cited authors

  • Sun, Hsin-Yun; Alexander, Barbara D.; Lortholary, Olivier; Dromer, Francoise; Forrest, Graeme N.; Lyon, G. Marshall; Somani, Jyoti; Gupta, Krishan L.; del Busto, Ramon; Pruett, Timothy L.; Sifri, Costi D.; Limaye, Ajit P.; John, George T.; Klintmalm, Goran B.; Pursell, Kenneth; Stosor, Valentina; Morris, Michelle I.; Dowdy, Lorraine A.; Munoz, Patricia; Kalil, Andre C.; Garcia-Diaz, Julia; Orloff, Susan; House, Andrew A.; Houston, Sally; Wray, Dannah; Huprikar, Shirish; Johnson, Leonard B.; Humar, Atul; Razonable, Raymund R.; Husain, Shahid; Singh, Nina

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.

Publication date

  • 2009

Published in

International Standard Serial Number (ISSN)

  • 1058-4838

Start page

  • 1721

End page

  • 1728

Volume

  • 49

Issue

  • 11