Therapeutic Drug Monitoring of Amphotericin-B in Plasma and Peritoneal Fluid of Pediatric Patients after Liver Transplantation: A Case Series
Francesca Tortora,
Luigi Dei Giudici,
Raffaele Simeoli,
Fabrizio Chiusolo,
Sara Cairoli,
Paola Bernaschi,
Roberto Bianchi,
Sergio Giuseppe Picardo,
Carlo Dionisi Vici,
Bianca Maria Goffredo
Affiliations
Francesca Tortora
Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Luigi Dei Giudici
Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Raffaele Simeoli
Department of Pediatric Specialties and Liver-kidney Transplantation, Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Fabrizio Chiusolo
Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Sara Cairoli
Department of Pediatric Specialties and Liver-kidney Transplantation, Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Paola Bernaschi
Unit of Microbiology and Diagnostic Immunology, Department of Diagnostic and Laboratory Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Roberto Bianchi
Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Sergio Giuseppe Picardo
Anesthesia and Critical Care Medicine, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
Carlo Dionisi Vici
Department of Pediatric Specialties and Liver-kidney Transplantation, Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Bianca Maria Goffredo
Department of Pediatric Specialties and Liver-kidney Transplantation, Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
Fungal infections represent a serious complication during the post-liver transplantation period. Abdominal infections can occur following pre-existing colonization, surgical procedures, and permanence of abdominal tubes. In our center, liposomal amphotericin-B is used as antifungal prophylaxis in pediatric patients undergoing liver transplantation. The aim of this study is to evaluate peritoneal levels of amphotericin-B following intravenous administration. Six liver recipients received liposomal amphotericin-B. Three of them were treated as prophylaxis; meanwhile, three patients received liposomal amphotericin-B to treat Candida albicans infection. Plasma and peritoneal amphotericin-B levels were measured by LC-MS/MS in two consecutive samplings. Cmin (pre-dose) and Cmax (2 h after the end of infusion) were evaluated as drug exposure parameters for both plasma and peritoneum. Our results showed that peritoneal amphotericin-B levels were significantly lower than plasma and that the correlation coefficient was 0.72 (p = 0.03) between plasma and peritoneal Cmin. Moreover, although peritoneal levels were within the therapeutic range, they never reached the PK/PD target (Cmax/MIC > 4.5). In conclusion, PK exposure parameters could be differently used to analyze amphotericin-B concentrations in plasma and peritoneum. However, liposomal amphotericin-B should be preferred in these patients as prophylactic rather than therapeutic treatment for fungal infections.
