Safety of aerosolized liposomal versus deoxycholate amphotericin B formulations for prevention of invasive fungal infections following lung transplantation: a retrospective study

Abstract

Background. Nebulized amphotericin B deoxycholate (AmBd) has been used to prevent invasive pulmonary aspergillosis after lung transplantation. Methods. In this retrospective study we compared the safety and tolerability of nebulized AmBd and nebulized liposomal amphotericin B (L‐AmB) in 38 consecutive lung transplant recipients. Progress notes, medication administration records, microbiology, and pulmonary function reports were reviewed. Histologic sections from lung tissue were examined. Plasma amphotericin B levels were measured. Results. A total of 1206 doses of AmBd and 1149 doses of L‐AmB were administered. Eighteen patients received AmBd only, 11 received L‐AmB only, and 9 received the medications sequentially. The total number of complaints vs. the number of doses administered was 1.0% for AmBd‐treated patients and 1.2% for L‐AmB‐treated patients. No differences were observed between the treatment groups on lung biopsy specimens. Plasma amphotericin B levels were <0.2–0.9 μg/mL in AmBd‐treated patients and <0.2 μg/mL in L‐AmB‐treated patients. Conclusions. In lung transplant recipients, both inhaled AmBd and L‐AmB were safe and well tolerated over a large number of medication exposures.