Prevention of Fungal and Hepatitis Virus Infections in Liver Transplantation

Abstract

Invasive fungal infections, especially those caused by Candida albicans, and recurrence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection after transplantation are common complications in orthotopic liver transplant (OLT) recipients. Candida species account for >50% of all invasive fungal infections, which occur in 10%--15% of OLT recipients. The epidemiology and pathogenesis of invasive fungal infections are unique to each type of organism. Fluconazole is effective and safe in the prevention of Candida infection after OLT. Preventive measures against Aspergillus or Cryptococcus remain ill defined. Both HBV and HCV recur almost universally after OLT in infected individuals. The natural course of HBV and HCV, leading to end-stage liver damage, is accelerated. In OLT patients, administration of immunoglobulin with high titers against HBV, alone and/or in combination with lamivudine, immediately after transplantation reduces the recurrence of HBV. The combination of interferon and ribavirin is mildly effective in OLT patients who have evidence of recurrent hepatitis, and additional alternatives are being evaluated.

Risk Factors and Impact of .BETA.-D Glucan on Invasive Fungal Infection for the Living Donor Liver Transplant Recipients

“…The risk factors for invasive fungal infection in liver transplantation have been reported by many authors (Gladdy et al 1999;Avery et al 2001;Paya 2001;Fortun et al 2002;Singh et al 2002;Takakura et al 2004). But these were identified mainly from their experiences with DDLT.…”

“…The incidence of fungal infection in liver transplantation is higher than in transplantation of other solid organs, ranging from 4 to 42% with a mortality of 25-69% (Patel et al 1996;Singh et al 1997Singh et al , 2002Rabkin et al 2000;Paya 2001). …”

Pulmonary aspergillosis in a patient with COPD due to PEG-interferon and ribavirin therapy for chronic hepatitis C

“…Fiuza et al described significant defects in neutrophil migration and phagocytosis with advenced cirrhosis [3]. Aspergillosis is one of these fungal infections and can be a major cause of morbidity and mortality in these immunocompetent patients with liver diseases especially following liver transplantations [4,5]. Very recently, Probrucin et al published a case of combined fungal infection in a patient with decompansated liver disease due to chronic hepatitis C and alcohol [6].…”

Infections After Orthotopic Liver Transplantation

“…[46][47][48] Risk factors for invasive candidiasis include the use of prophylactic antibiotics to prevent spontaneous bacterial peritonitis, the need for renal replacement therapy (hemodialysis) postoperatively, and retransplantation. 44 Other potential risk factors include technically complicated and lengthy transplantation operative procedures, intraoperative transfusion, prolonged ICU admission, repeated intra-abdominal surgery after transplantation, Candida colonization, and cytomegalovirus disease.…”

“…44 Other potential risk factors include technically complicated and lengthy transplantation operative procedures, intraoperative transfusion, prolonged ICU admission, repeated intra-abdominal surgery after transplantation, Candida colonization, and cytomegalovirus disease. 48 CMV disease is a clear risk factor for all types of invasive candidal infections, and effective prophylaxis of patients at high risk for CMV disease, such as those who are CMV D+/ RÀ (donor positive, recipient negative), has been shown to significantly decrease the incidence of invasive Candida infection in the absence of specific anti-Candida prophylaxis. 49 It is now routine that transplant centers use routine antifungal prophylaxis with the majority of studies have showing clear reduction in rates of colonization, incidence fungal infections, and mortality (attributable to fungal infection).…”