Lipid formulations of amphotericin B significantly improve outcome in solid organ transplant recipients with central nervous system cryptococcosis.
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.
Sun, H-Y; Alexander, BD; Lortholary, O; Dromer, F; Forrest, GN; Lyon, GM; Somani, J; Gupta, KL; del Busto, R; Pruett, TL; Sifri, CD; Limaye, AP; John, GT; Klintmalm, GB; Pursell, K; Stosor, V; Morris, MI; Dowdy, LA; Munoz, P; Kalil, AC; Garcia-Diaz, J; Orloff, S; House, AA; Houston, S; Wray, D; Huprikar, S; Johnson, LB; Humar, A; Razonable, RR; Husain, S; Singh, N
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