%0 Journal Article %1 Monforte2009 %A Monforte, Víctor %A Ussetti, Piedad %A López, Rosa %A Gavaldà, Joan %A Bravo, Carles %A de Pablo, Alicia %A Pou, Leonor %A Pahissa, Albert %A Morell, Ferran %A Román, Antonio %D 2009 %J J Heart Lung Transplant %K fungal transplantation prophylaxis toxicity %N 2 %P 170--175 %R 10.1016/j.healun.2008.11.004 %T Nebulized liposomal amphotericin B prophylaxis for Aspergillus infection in lung transplantation: pharmacokinetics and safety. %U http://dx.doi.org/10.1016/j.healun.2008.11.004 %V 28 %X The main problem with using nebulized liposomal amphotericin (n-LAB) as prophylaxis for Aspergillus infection after lung transplantation is the lack of knowledge of its pharmacokinetics and its possible adverse effects. The aim of this study was to measure post-inhalation amphotericin B concentration in the respiratory tract and serum of lung transplant patients and assess the effects of n-LAB on respiratory function.Thirty-two consecutive bronchoscopies were performed on 27 lung transplant patients at two hospitals. Amphotericin B concentration in the first and third aliquot of bronchoalveolar lavage material was measured in steady state. The first aliquot approximates most closely the true amphotericin B concentrations in the proximal airway, whereas the third aliquot provides an optimum sample from the distal airway.At 2 days, mean amphotericin B concentrations were 11.1 microg/ml (95\% confidence interval CI: 16.5 to 5.7 microg/ml) and 9.0 microg/ml (95\% CI: 14.3 to 3.8 microg/ml) in the first and third aliquot, respectively. Thereafter, concentrations declined progressively. At 14 days, concentrations were 3.0 microg/ml (95\% CI: 4.4 to 1.5 microg/ml) in the first aliquot and 4.1 microg/ml (95\% CI: 6.1 to 2.1 microg/ml) in the third aliquot (p = not statistically significant). Traces of amphotericin B (0.1 microg/ml) were found in serum samples from only 1 of 27 patients. Mean value of forced expiratory volume in the first second (FEV(1)) was similar before and after n-LAB.Amphotericin B concentrations after n-LAB remained high for 14 days, at adequate concentrations for prophylaxis of Aspergillus infection. No significant systemic absorption of amphotericin B was detected and no effect was observed on respiratory function. This promising prophylactic regimen warrants assessment in future clinical studies.

@article{Monforte2009, abstract = {The main problem with using nebulized liposomal amphotericin (n-LAB) as prophylaxis for Aspergillus infection after lung transplantation is the lack of knowledge of its pharmacokinetics and its possible adverse effects. The aim of this study was to measure post-inhalation amphotericin B concentration in the respiratory tract and serum of lung transplant patients and assess the effects of n-LAB on respiratory function.Thirty-two consecutive bronchoscopies were performed on 27 lung transplant patients at two hospitals. Amphotericin B concentration in the first and third aliquot of bronchoalveolar lavage material was measured in steady state. The first aliquot approximates most closely the true amphotericin B concentrations in the proximal airway, whereas the third aliquot provides an optimum sample from the distal airway.At 2 days, mean amphotericin B concentrations were 11.1 microg/ml (95\% confidence interval [CI]: 16.5 to 5.7 microg/ml) and 9.0 microg/ml (95\% CI: 14.3 to 3.8 microg/ml) in the first and third aliquot, respectively. Thereafter, concentrations declined progressively. At 14 days, concentrations were 3.0 microg/ml (95\% CI: 4.4 to 1.5 microg/ml) in the first aliquot and 4.1 microg/ml (95\% CI: 6.1 to 2.1 microg/ml) in the third aliquot (p = not statistically significant). Traces of amphotericin B (0.1 microg/ml) were found in serum samples from only 1 of 27 patients. Mean value of forced expiratory volume in the first second (FEV(1)) was similar before and after n-LAB.Amphotericin B concentrations after n-LAB remained high for 14 days, at adequate concentrations for prophylaxis of Aspergillus infection. No significant systemic absorption of amphotericin B was detected and no effect was observed on respiratory function. This promising prophylactic regimen warrants assessment in future clinical studies.}, added-at = {2013-03-29T23:13:56.000+0100}, author = {Monforte, Víctor and Ussetti, Piedad and López, Rosa and Gavaldà, Joan and Bravo, Carles and {de Pablo}, Alicia and Pou, Leonor and Pahissa, Albert and Morell, Ferran and Román, Antonio}, biburl = {https://www.bibsonomy.org/bibtex/23e94c6dbbaa54fc143712313e652a87a/aorchid}, description = {see page 91 notebook 2. Find levels are adequate in BALF for 14d, but not known about anastomosis site.}, doi = {10.1016/j.healun.2008.11.004}, file = {:ID_General/TransplantClinical/JHeartLungTransplant.28.170.pdf:PDF}, groups = {public}, institution = {orte@vhebron.net}, interhash = {73e75812ec43ad8e7880c1beb109e765}, intrahash = {3e94c6dbbaa54fc143712313e652a87a}, journal = {J Heart Lung Transplant}, keywords = {fungal transplantation prophylaxis toxicity}, language = {eng}, medline-pst = {ppublish}, month = Feb, number = 2, pages = {170--175}, pii = {S1053-2498(08)00789-4}, pmid = {19201343}, timestamp = {2013-03-29T23:13:56.000+0100}, title = {Nebulized liposomal amphotericin B prophylaxis for Aspergillus infection in lung transplantation: pharmacokinetics and safety.}, url = {http://dx.doi.org/10.1016/j.healun.2008.11.004}, username = {aorchid}, volume = 28, year = 2009 }