• Pablo Solís-Muñoz, Juan Carlos López, William Bernal, Christopher Willars, Ana Verma, Michael A Heneghan, Julia Wendon, and Georg Auzinger.
• Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital of London, United Kingdom. pablo.a.solis@hotmail.com
• J. Infect. 2013 Jan 1; 66 (1): 80-6.

UnlabelledThere are no studies regarding to these effects in patients with severe liver dysfunction.ObjectivesThe aims of this study were to characterize voriconazole hepatotoxicity in patients with severe liver dysfunction and to compare it with a matched cohort treated with liposomal amphotericin B.MethodsThis is an observational study, in which adults patients treated with at least 4 doses of voriconazole were included. Patients treated with liposomal amphotericin B were used as control group.ResultsSixty nine percent of patients treated with voriconazole showed changes in liver function tests (LFTs) during therapy. They showed elevated transaminases in 35%, cholestasis in 15% or a combination of both in 45%. According to the CTC classification, all patients with hepatotoxicity had a severe reaction. The Roussel Uclaf Causality Assessment Method score in all patients with hepatotoxicity was greater than 8. There was a correlation between initial loading dose greater than 300 mg (4.5 mg/kg) and the risk of hepatotoxicity (p < 0.001). The control group developed alterations in the LFTs in only 10.3% of patients.ConclusionVoriconazole should be used with caution in patients with severe liver dysfunction and following liver transplantation, with frequent monitoring of LFTs or using liposomal amphotericin B instead.Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

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