A retrospective analysis of the use of caspofungin in recipients of liver transplant with a modified high index of suspicion for fungal infection. A critical review of mortality, acute cellular rejection, infections, and changes in the liver function tests while on caspofungin

Doria, Cataldo; Bodzin, Adam S.; Vaccino, Silvia; Daskalakis, Constantine; Krawitz, Steven; Ramirez, Carlo B.

doi:10.1111/j.1399-0012.2010.01308.x

Cited by 9 publications

(10 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fungal infection is not uncommon after LT. Some studies have demonstrated that the incidence of fungal infection in LT recipients ranged from 16% to 42% (22,23). Castaldo et al (24) reported that the incidence of fungal infection after LT was 25.3% in 178 adult recipients, and 7.3% of adult recipients died of fungal infection.…”

Section: Discussionmentioning

confidence: 99%

In-hospital mortality of liver transplantation and risk factors: a single-center experience

Zhang¹,

Fan²,

Wu³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

Background: Liver transplantation (LT) is a life-saving treatment for patients with end-stage liver disease and acute liver failure. However, in-hospital death cannot be avoided. We designed this study to analyze patients' in-hospital mortality rate after LT and the factors correlated with in-hospital death.Methods: The data of patients who received LT in our hospital between January 11, 2015, and November 19, 2019, were obtained from the China Liver Transplant Registry and medical records. The in-hospital mortality rate was calculated, and factors related to mortality, cause of death, and factors related to cause of death were analyzed by reviewing patients' data.Results: A total of 529 patients who underwent cadaveric LT were enrolled in this study. Modified piggyback orthotopic LT was performed for all patients. Seventy patients died in the hospital after LT, and the in-hospital mortality rate was 13.2%. Factors including model for end-stage liver disease (MELD) score, Child-Pugh grading, intraoperative blood loss, and anhepatic phase were correlated with in-hospital death. MELD score and intraoperative blood loss were determined as the two independent risk factors of in-hospital death. The first two causes of death were infection (34.3%) and primary non-function (15.7%).Pulmonary fungal infection was the main cause of infectious death. MELD score was the independent risk factor for infectious death, and both body mass index of donors and cold ischemic time were independent risk factors of primary non-function.Conclusions: In-hospital death poses a threat to certain patients undergoing LT. Our study suggests that the main cause of in-hospital death is an infection, followed by primary non-function.

show abstract

Section: Discussionmentioning

confidence: 99%

In-hospital mortality of liver transplantation and risk factors: a single-center experience

Zhang¹,

Fan²,

Wu³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…In LT, caspofungin is associated with a significantly higher risk of adverse events, especially acute renal failure ( p = 0.001), even though it does not carry an apparent increase in the risk of death or acute cellular rejection in LT [20]. Thus, voriconazole is the preferred antifungal therapy in SOT, regardless of possible influence in the tacrolimus metabolism in human liver microsomes [21].…”

Section: Discussionmentioning

confidence: 99%

Lethal thrombosis of the iliac artery caused by Aspergillus fumigatus after liver transplantation: case report and review of the literature

Gundlach

Günther²,

Fickenscher

et al. 2019

BMC Surg

View full text Add to dashboard Cite

BackgroundAspergillus fumigatus infections frequently occur after solid organ transplantation. Yet, a fungal thrombosis after liver transplantation is an exceptional finding.Case presentationWe report on a 44-year-old female with an aspergillosis after liver transplantation for autoimmune hepatitis. On postoperative day (pod) 7, seizures occurred and imaging diagnostics revealed an intracranial lesion. Anidulafungin was initiated in suspicion of mycosis and switched to voriconazole on suspicion of an Aspergillus spp. infection. Progression of the cerebral lesion prompted craniotomy (pod 48) and the aspergillosis was verified. The patient was discharged with oral voriconazole therapy. Re-admission was necessary with acute-on-chronic renal failure after a tacrolimus overdose on pod 130. The patient received a pelvic angiography due to a temperature difference in the legs. It showed a complete iliac artery thrombosis which was subsecutively surgically removed. The histopathological examination revealed an Aspergillus fumigatus conglomerate. The patient died on pod 210 due to systemic aspergillosis.ConclusionThe acute development of focal neurologic deficits is common in patients with an aspergillosis of the brain. Nevertheless, arterial thrombosis after Aspergillus fumigatus is less frequent and, to the best of our knowledge, its occurrence after liver transplantation has not yet been reported so far. Due to its rarity, we added a review of the literature to this manuscript.

show abstract

“…Echinocandins have been used safely in patients with preexisting hepatic impairment, namely, caspofungin in patients with chronic liver disease and postliver transplantation. Micafungin and anidulafungin have been used in patients with hepatic impairment; no worsening of the disease was observed [59, 60]. …”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity of Antimycotics Used for Invasive Fungal Infections: In Vitro Results

Doß

Potschka

Mitzner

et al. 2017

BioMed Research International

View full text Add to dashboard Cite

Purpose. Drug-induced liver injury (DILI) is the most common cause of liver injury and a serious clinical problem; antimycotics are involved in approximately 3% of all DILI cases. The hepatotoxicity of many drugs, including the antimycotics, is poorly screened in human models. Methods. In a standardized assay the cytotoxicity on hepatocytes of different concentrations (Cmax, 5x Cmax, and 10x Cmax) of the antimycotics used for systemic infections was tested. Anidulafungin (ANI), liposomal amphotericerin B (L-AmB), caspofungin (CASPO), fluconazole (FLUCO), and voriconazole (VORI) were incubated with HepG2/C3A cells. After incubation, the viability of cells (XTT test, LDH release, trypan blue staining), the synthesis of albumin, the cytochrome 1A2 activity, and the cell death (DNA fragmentation) were determined. Kruskal-Wallis and Mann–Whitney tests were used for statistical analyses. Results. L-AmB, ANI, and CASPO showed a mild hepatotoxicity in the Cmax concentrations. Higher concentrations of anidulafungin led to a severe impairment of hepatocyte viability and function. The azoles FLUCO and VORI had a higher hepatotoxic potential in all concentrations. Conclusion. Antimycotics, especially azoles, used for systemic infections should be given with caution in patient with liver insufficiency or liver failure or high risk for this; therefore, therapeutic drug monitoring should be used. Further studies with this approach are encouraged.

show abstract

A retrospective analysis of the use of caspofungin in recipients of liver transplant with a modified high index of suspicion for fungal infection. A critical review of mortality, acute cellular rejection, infections, and changes in the liver function tests while on caspofungin

Cited by 9 publications

References 15 publications

In-hospital mortality of liver transplantation and risk factors: a single-center experience

In-hospital mortality of liver transplantation and risk factors: a single-center experience

Lethal thrombosis of the iliac artery caused by Aspergillus fumigatus after liver transplantation: case report and review of the literature

Hepatotoxicity of Antimycotics Used for Invasive Fungal Infections: In Vitro Results

Contact Info

Product

Resources

About