Fungal Infections in Liver Transplant Recipients

Abstract

Sixty-two adults who underwent orthotopic liver transplantations between February 1981 and June 1983 were followed for a mean of 170 days after the operation. Twenty-six patients developed 30 episodes of significant fungal infection. Candida species and Torulopsis glabrata were responsible for 22 episodes and Aspergillus species for 6. Most fungal infections occurred in the first month after transplantation. In the first 8 weeks after transplantation, death occurred in 69% (18/26) of patients with fungal infection but in only 8% (3/36) of patients without fungal infection (P less than 0.0005). The cause of death, however, was usually multifactorial, and not solely due to the fungal infection. Fungal infections were associated with the following clinical factors: administration of preoperative steroids (P less than 0.05) and antibiotics (P less than 0.05), longer transplant operative time (P less than 0.02), longer posttransplant operative time (P less than 0.01), duration of antibiotic use after transplant surgery (P less than 0.001), and the number of steroid boluses administered to control rejection in the first 2 posttransplant months (P less than 0.01). Patients with primary biliary cirrhosis had fewer fungal infections than patients with other underlying liver diseases (P less than 0.05). A total of 41% (9/22) of Candida infections resolved, but all Aspergillus infections ended in death.

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

“…In early studies, the incidence of IFI in this setting ranged from 18% to 42%, and the associated mortality rates were 50% to 78%. [1][2][3][4][5][6] Candida species accounted for the majority of infections, and many patients infected with Candida organisms survived. In contrast, infections caused by Aspergillus species were nearly always fatal.…”

“…In contrast, infections caused by Aspergillus species were nearly always fatal. 2,3,6 We showed that in liver transplant recipients considered high risk for IFI, fluconazole prophylaxis reduced the incidence of invasive candidiasis 7 but was complicated by the emergence of fluconazole-resistant fungi and failed to prevent invasive aspergillosis. 8 A recent randomized, placebo-controlled trial of liver transplant recipients showed that prophylaxis with fluconazole was associated with a decrease in fungal colonization and fewer deaths related to IFI, but did not improve overall survival.…”

Aspergillosis of the CNS in a Pediatric Liver Transplant Recipient: Case Report and Review

“…Cases of invasive aspergillosis have been reported after transplantation of the liver [2][3][4][5][6], kidney [1,[7][8][9][10][11], and heart [12][13][14][15]. Aspergillosis was diagnosed in 9 % of adult liver transplant recipients who received immunosuppressive therapy consisting of administration of azathioprine, prednisone, and antilymphocyte globulin [2].…”

“…Aspergillosis was diagnosed in 9 % of adult liver transplant recipients who received immunosuppressive therapy consisting of administration of azathioprine, prednisone, and antilymphocyte globulin [2]. Similarly, 6 % of adult liver transplant recipients treated with cyclosporine and prednisone developed aspergillosis [3,4] . All patients with aspergillosis from those three series of liver transplantations [2][3][4] [1,[7][8][9][10][11] has survived.…”

“…Similarly, 6 % of adult liver transplant recipients treated with cyclosporine and prednisone developed aspergillosis [3,4] . All patients with aspergillosis from those three series of liver transplantations [2][3][4] [1,[7][8][9][10][11] has survived. Similar survival rates among heart transplant recipients and an occasional survivor of pulmonary disease have been reported, but none of such patients in whom the aspergillosis involved the CNS survived [12][13][14][15] .…”