Treatment of invasive fungal infections with amphotericin B is a concern in kidney transplant patients due to fear of allograft loss. Reluctance to use amphotericin B may lead to suboptimal therapy and poor treatment outcomes. The risk of amphotericin B-related nephrotoxicity and allograft dysfunction has not been studied in kidney transplant patients. Our aim is to study the association between amphotericin B and acute kidney injury (AKI) as defined by the Acute Kidney Injury Network classification, allograft loss and patient mortality in kidney transplant recipients.
We used SPSS to conduct a descriptive analysis of a retrospective cohort of 30 adult kidney transplant recipients who were admitted to Virginia Commonwealth University Medical Center and received treatment with amphotericin B from 2005 to 2015.
The median age in our cohort was 57. 40% were female, 60% were male. 60% had received a kidney transplant from a deceased donor; 13.3% from a living related donor; 13.3% from a living unrelated donor; and 13.3% had received a combined kidney-pancreas transplant. 63.3% of patients had received liposomal amphotericin B; 33.3% had received lipid-complex amphotericin B; 3.3% had received conventional amphotericin B. We found an association between cumulative amphotericin B doses above 5,000 milligrams and AKI, whereby 64.7% of patients exposed to less than 5,000 milligrams of amphotericin B developed AKI and 100% of patients exposed to more than 5,000 milligrams of amphotericin B developed AKI (p=0.017). We did not find an association between cumulative amphotericin B doses above 5,000 milligrams and return to dialysis at 3 months and 12 months post-exposure (p=0.436 and 0.288 respectively). We also did not find an association between such doses of amphotericin B and mortality at 30 and 90 days (p=0.869 and 0.193 respectively).
In the first descriptive analysis of a retrospective cohort of kidney transplant patients exposed to amphotericin B, our results suggest that the risk of nephrotoxicity may be significantly increased when a cumulative dose of 5,000 milligrams is exceeded. Our results also suggest that amphotericin B doses associated with nephrotoxicity in kidney transplant patients may not have an effect on allograft survival and patient mortality.
I. Yakubu, None
G. Gupta, None
N. Kurbanova, None
O. De La Cruz, None