Aspergillosis in children after liver transplantation: Single center experience

Abstract

Aspergillus infection in immunocompromised patients is associated with high morbidity and mortality. We retrospectively reviewed cases of Aspergillosis (A), in a series of 277 children who received LTx between 1990 and 2006. All children were given antifungal prophylaxis after transplantation. Aspergillosis was identified in 10 cases (3.6%) and diagnosis was confirmed when clinical symptoms were associated with identification of Aspergillus sp. or detection of galactomannan antigen. Incidence of Aspergillosis considerably decreased from 6.9% to 0.6% when liposomal amphotericin B was introduced as prophylaxis in high-risk patients. Mean time since LTx to Aspergillosis was 14.5 days. Histologically, Aspergillosis was diagnosed in two cases. Galactomannan antigen was present in two recipients. Aspergillus infection occurs usually within first 30 days after transplantation as a result of a combination of several risk factors. Following risk factors were observed: multiple antibiotic therapy, prolonged intensive care unit stay, poor graft function, retransplantation, relaparotomies, co-infection. Amphotericin B was administered in all cases. Two patients (20%) died because of Aspergillosis Liposomal Amphotericin B prophylaxis in high-risk children decreases the incidence of Aspergillus infection. High index of suspicion and early diagnosis followed by intensive treatment with amphotericin B facilitates achieving mortality rate lower than presented in other reports.

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

“…Additionally, the outcome was not reported for 141 cases, whereas in 174 cases, more than 50% of the characteristics required for the analysis were lacking. Therefore, 116 individual cases in all were analyzed …”

Invasive aspergillosis in liver transplant recipients

“…The mean time between LT and aspergillosis was 14.5 days and several risk factors were identified: multiple antibiotic therapy, prolonged ICU stay, poor graft function, re‐transplantation, re‐laparotomies, and co‐infections. In the largest cohort of 139 IA diagnosed in children, 62.6% of them had hematological malignancies and 11.5% had solid transplants ( n = 16), among which three were LT recipients 273 . In this cohort, risk factors for death were bone marrow transplant, GvHD, immunosuppression, and surgery after diagnosis 273 …”

“…The overall incidence of IFI in pediatric SOT recipients was estimated at 2.2%, and was higher, from 3.6% to 4.7% (8/172) in LT recipients 272 , 273 . This incidence decreased drastically from 6.9% to 0.6% with the use of liposomal amphotericin B prophylaxis (1 mg/kg/day intravenous during 5 days) in high‐risk LT children leading to the proposal of antifungal prophylaxis on a case‐by‐case basis 273 .…”

Role of Molecular Biomarkers in the Diagnosis of Invasive Fungal Diseases in Children

“…To date, 23 studies with the GM assay have been performed in children, including 18 prospective [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Table 2) and 5 retrospective [33][34][35][36][37] studies. Many of these studies have been reviewed [38][39][40].…”