Safety and Efficacy of Liposomal Amphotericin B for Patients With Invasive Mold Diseases in Liver Transplant Recipients

Invasive mold diseases (IMD) carry extremely high mortality rates in liver transplant recipients (aspergillosis prevalence ~1.8%, mortality 60%-90%; mucormycosis prevalence ~2%, mortality 38%-95%). Guidelines emphasize early antifungal therapy: liposomal amphotericin B (L-AmB) is the first-line choice in liver insufficiency; voriconazole remains the gold standard for aspergillosis (but ineffective against mucormycosis), yet its use is limited by significant drug-drug interactions-requiring a 50%-60% dose reduction of calcineurin inhibitors and contraindicated with sirolimus-thereby increasing the risk of graft rejection. Currently, no head-to-head clinical trials compare voriconazole and L-AmB in liver transplant recipients with IMD. Therefore, a prospective real-world study is planned to generate robust data to support updates to international or Chinese guidelines.

Study Overview

• Status: Not yet recruiting
• Conditions: Invasive Mold Diseases
• Intervention / Treatment: Drug: AmBisome (Amphotericin B) Liposome

Detailed Description

Invasive mold diseases (IMD) represent a significant cause of morbidity and mortality among solid organ transplant (SOT) recipients. Liver transplant recipients are at heightened risk for developing IMD due to complex biliary-enteric anastomosis and underlying immunological deficits associated with liver dysfunction and the need for immunosuppressive therapy. Among SOT patients, invasive aspergillosis is the second most common invasive fungal infection and poses a substantial mortality risk, especially for those who have undergone liver transplantation. Current research indicates that 1.8% of liver transplant recipients develop invasive aspergillosis, with mortality rates reported between 60% and 90%.

While mucormycosis is less prevalent than invasive aspergillosis-accounting for approximately 2% of fungal infections in SOT recipients-it is associated with a poor prognosis, with mortality rates ranging from 38% to 95% in this population. These statistics highlight the critical need for effective antifungal therapies in the management of IMD among liver transplant patients.

Guidance from the 2019 American Society of Transplantation Infectious Diseases Community of Practice (ASTIDCOP) underscores the importance of early antifungal therapy initiation to optimize outcomes for SOT recipients affected by invasive aspergillosis. The primary antifungal drug classes used for treating invasive aspergillosis include polyenes, triazoles, and echinocandins. In the context of liver insufficiency, liposomal amphotericin B (L-AmB) is typically considered the first-line therapeutic option.

For mucormycosis, the 2019 guidelines from the European Confederation of Medical Mycology (ECMM) and the Mycoses Study Group Education and Research Consortium (MSGERC) recommend liposomal amphotericin B (L-AmB) as the first-line treatment. However, there are currently no international guidelines specifically addressing the management of mucormycosis in solid organ transplant recipients.

Voriconazole remains the preferred agent for treating invasive aspergillosis and is considered the standard of care. Lipid formulations of L-AmB are regarded as alternative treatment options for invasive aspergillosis. However, voriconazole is not recommended for the treatment of mucormycosis. Although voriconazole, a triazole antifungal agent, offers broad-spectrum activity against various yeast and mold species and is the current gold standard for invasive aspergillosis, its use is constrained by drug-drug interactions and safety concerns.

Liver function has a significant impact on the pharmacokinetics of antifungal agents, which is particularly relevant in liver transplant recipients. Both cyclosporine and tacrolimus are extensively metabolized by CYP3A4 and CYP3A5, necessitating a 50% to 60% reduction in the dosage of these calcineurin inhibitors when administered with voriconazole. The coadministration of voriconazole with sirolimus is contraindicated. Reducing the dose of immunosuppressive agents may increase the risk of graft rejection, presenting a therapeutic challenge in this patient population.

No direct head-to-head clinical trials have compared voriconazole and AmBisome for treating invasive mold infections in liver transplant recipients, especially regarding adverse reactions. This prospective, bigger scale, real-world study aims to fill the gap by evaluating both drugs such as IMD patients with liver transplantation to facilitate robust scientific data support for updated international or Chinese guideline

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients aged ≥12 years. Liver transplant recipients. Proven or probable invasive mold disease (IMD) according to the 2020 EORTC/MSGERC criteria.

Have received at least one dose of liposomal amphotericin B (AmBisome) or voriconazole.

Exclusion Criteria:

History of invasive mold disease previously treated with amphotericin B for more than 5 days.

Documented hypersensitivity or allergy to amphotericin B formulations. Sequential Organ Failure Assessment (SOFA) score >15. Expected survival <72 hours. Pregnant or breastfeeding. Patients who, in the investigator's judgment, are unable to complete the study treatment or follow the study protocol.

Recipients of combined organ transplantation or multivisceral transplantation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: evaluate the safety of liposomal amphotericin B (AmBisome) in liver transplant recipients with IMD; This study aims to describe the safety profiles and clinical characteristics of liposomal amphotericin B (AmBisome) or voriconazole as first-line therapies for invasive mold disease (IMD) in liver transplant recipients, utilizing historical matched-control analysis across 10 study sites. Specifically, a 1:2 propensity score matching (PSM) method will be applied to compare the prospectively enrolled AmBisome group (60 patients) with a historical voriconazole group (120 patients). The primary safety endpoints include: nephrotoxicity, hepatotoxicity, hypokalemia, cardiotoxicity (QT interval changes), infusion-related reactions, tacrolimus dose and trough concentration changes, and treatment-related serious adverse events leading to discontinuation or death (graded per CTCAE v5.0).

Drug: AmBisome (Amphotericin B) Liposome; This intervention is applied prospectively to the AmBisome group (target enrollment: 60 patients). The study does not mandate a fixed dose or fixed course length; rather, it reflects real-world clinical practice. All safety parameters (hepatotoxicity, nephrotoxicity, hypokalemia, cardiotoxicity, infusion reactions, tacrolimus dose/concentration changes, and serious adverse events) are longitudinally monitored during the intervention period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary endpoint of this study is the safety profile of liposomal amphotericin B (AmBisome) in liver transplant recipients with invasive mold disease	The primary endpoint of this study is to comprehensively evaluate the safety profile of liposomal amphotericin B (AmBisome) in liver transplant recipients diagnosed with invasive mold disease (IMD). Safety will be assessed by systematically monitoring the incidence, severity, timing, and outcomes of treatment-emergent adverse events (TEAEs) occurring during and after AmBisome therapy. Particular attention will be paid to adverse events of special interest associated with amphotericin B treatment, including nephrotoxicity, electrolyte disturbances (such as hypokalemia and hypomagnesemia), infusion-related reactions, hepatotoxicity, hematologic abnormalities, and other clinically significant laboratory abnormalities.	The comprehensive assessment for the primary safety endpoint will be performed at Week 6 (±7 days) after the initiation of antifungal therapy. If a patient prematurely discontinues treatment for any reason, the assessment time point will be at the time o

Collaborators and Investigators

• Sponsor: Beijing Friendship Hospital

Study record dates

Study Major Dates

• Study Start (Estimated): August 8, 2026
• Primary Completion (Estimated): May 15, 2028
• Study Completion (Estimated): August 15, 2028

Study Registration Dates

• First Submitted: July 9, 2026
• First Submitted That Met QC Criteria: July 22, 2026
• First Posted (Actual): July 24, 2026

Study Record Updates

• Last Update Posted (Actual): July 24, 2026
• Last Update Submitted That Met QC Criteria: July 22, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Organic Chemicals; Pharmaceutical Preparations; Dosage Forms; Biomedical and Dental Materials; Manufactured Materials; Technology, Industry, and Agriculture; Macrolides; Lactones; Polyketides; Membranes, Artificial; Drug Carriers; Biomimetic Materials; Amphotericin B; Liposomes; liposomal amphotericin B
• Other Study ID Numbers: BFH20260625003

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No