Role of liposomal amphotericin B (AmBisome) in the prophylaxis of mycoses after liver transplantation.

The incidence of invasive fungal infection (IFI) after liver transplantation (LTx) ranges from 5 to 42% [1]. Candida albicans and Aspergillus fumigatus are the most common pathogens in liver graft recipients, who are more susceptible to IFIs than any other type of solid organ transplant recipient. Onset of fungal infection is mainly within the first two months after LTx which is associated with a high mortality of up to 100% for systemic aspergillus infection [2,3]. The high rate of IFI in liver transplant patients is related to difficulties in establishing an early diagnosis, lack of effective therapy in many situations, difficult management of certain antifungal drugs, and limited data on effective regimens for antifungal prophylaxis [2,4]. However, amphotericin B is still the gold standard for the treatment of IFI, but its use is limited by adverse effects, mainly nephrotoxicity [5]. All of the current antimycotics cause various adverse effects. Simultaneous administration of fluconazole with cyclosporine or tacrolimus might cause increased trough levels of cyclosporine and tacrolimus by inhibition of cytochrome P450 3A [6,7]. New therapeutic approaches using immunomodulators (e.g. interferon-γ) are under investigation as adjuvants for antimycotic therapy [8]. A new potential alternative to amphotericin B is the liposomal formulation Ambisome®, a small unilammellar liposome preparation (diameter 45-80 nm) containing amphotericin B in the bilayer, which shows reduced toxicity and elevated peak plasma level compared with conventional amphotericin B without loss of the broadspectrum antifungal activity of amphotericin B [9,10]. These attributes make liposomal amphotericin B attractive for prophylactic use in liver transplantation. Patients and Methods