Efficiency and Safety of Inhaled Amphotericin B Lipid Complex (Abelcet) in the Prophylaxis of Invasive Fungal Infections Following Lung Transplantation

• DOI: 10.1016/j.transproceed.2008.09.020
• Publication Date: 2008-11-18T05:56:46Z
• Authors: J.M. Borro; A. Solé; M. de la Torre; A. Pastor; R. Fernandez; A. Saura; M. Delgado; E. Monte; D. Gonzalez
• Keywords: Adult; Male; 0303 health sciences; Antifungal Agents; Adolescent; Administration, Oral; Nausea; Middle Aged; 3. Good health; 03 medical and health sciences; Mycoses; Risk Factors; Amphotericin B; Administration, Inhalation; Aspergillosis; Humans; Female; Safety; Child; Fluconazole; Aged; Lung Transplantation; Retrospective Studies

Invasive fungal infections (IFIs) in patients undergoing lung transplantation (LT) are associated with significant mortality. Previous studies have shown the efficacy of aerosolized amphotericin B deoxycholate and oral fluconazole for antifungal prophylaxis. Evolving data show a potential advantage of prophylaxis with lipid-based formulations of amphotericin B in the prevention of IFIs. We reviewed the incidence of IFIs among patients receiving aerosolized amphotericin B lipid complex (ABLC) in LT.We undertook a retrospective review of the results of our antifungal protocol in a cohort of 60 LT patients. We analyzed the efficiency, safety, and tolerability of 50 mg of aerosolized ABLC administered postoperatively for IFI prophylaxis once every 2 days for 2 weeks and then once per week for at least 13 weeks. In addition, these transplanted patients received fluconazole (200 mg/d) during the first 21 days posttransplant. The prophylaxis-related efficiency and safety were quantified for IFIs and adverse events (AEs) for 6 months after study drug initiation.Prophylaxis was efficient in 59 (98.3%) patients. Only one patient developed a possible IFI, due to Aspergillus fumigatus. Four patients presented nausea and vomiting as an AE, although aerosolized amphotericin B was ongoing.Nebulized ABLC was effective, safe, and well tolerated for the prophylaxis of aspergillosis in lung transplant patients during the early posttransplant period.