Pretransplant model for end stage liver disease score predicts posttransplant incidence of fungal infections after liver transplantation

Abstract

Liver transplant recipients are at a significant risk for invasive fungal infections (IFI). This retrospective study evaluated the impact of the pretransplant model for end stage liver disease (MELD) on the incidence of posttransplant IFI in a single centre. From 2004 to 2008, 385 liver transplantations were included, from which 210 transplantations were conducted allocated by Child Turcotte Pugh and 175 were allocated by MELD score. Both groups differed regarding the age of transplant recipients (50.1 ± 10.7 vs. 52.5 ± 9.9, P = 0.036), pretransplant MELD score (16.43 ± 8.33 vs. 18.29 ± 9.05), rate of re-transplantations, duration of surgery, demand in blood transfusions and rates of renal impairments. In the MELD era, higher incidences of IFI (pre-MELD 11.9%, MELD 24.0%, P < 0.05) and Candida infections (9% vs. 18.9%, P < 0.05) were observed. There was no difference in the incidence of probable or possible aspergillosis. Mortality, length of stay in intensive care or hospital, and duration of mechanical ventilation did not differ between the pre-MELD and MELD era. Regardless the date of transplantation, patients with fungi-positive samples showed higher mortality rates than patients without. MELD score was analysed as independent predictors for posttransplant IFI. Higher MELD scores predispose to a more problematic postoperative course and are associated with an increase in fungal infections.

Targeted Versus Universal Antifungal Prophylaxis Among Liver Transplant Recipients

“…The data offer further support for the effectiveness of antifungal prophylaxis in these high-risk settings. In contrast to two recent studies(27, 28), we did not identify pre-transplant model for end stage liver disease (MELD) score to be associated with IFIs. In fact, the IFI rate in patients with MELD score ≥ 30 was only 3.4% and did not significantly differ between targeted and universal groups.…”

Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis?

“…While MELD score of ≥20 is associated with increased risk of bacteremia, LDLT recipients with a MELD score of ≥25 are at increased risk of pneumonia [29, 30]. With regard to systemic mycosis, few studies showed that high MELD score of ≥20 was predictive of IFI [31, 32]. Our result was in agreement with these previous reports.…”

Randomized Trial of Micafungin for the Prevention of Invasive Fungal Infection in High-Risk Liver Transplant Recipients

“…Risk factors associated with IFI in liver transplant recipients include pre- and postoperative renal failure, retransplantation, substantial intraoperative transfusion of cellular blood products [9], and high Model for End-Stage Liver Disease (MELD) score [2, 12, 13]. As IFIs are associated with mortality rates of 25%–90% [2, 4, 9, 14, 15], antifungal prophylaxis is a rational approach for liver transplant patients considered at high risk.…”