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

Abstract

infection is a fatal complication in liver transplantation and it is very difficult to diagnose at the early stage. The aim of this study was to review our experience with invasive fungal infections in living donor liver transplantation (LDLT) and to analyze the risk factors and the impact of β -D glucan. From 1991 to 2005, 96 LDLTs were performed in our institution and we measured the serum level of β -D glucan in order to clarify the diagnosis. Invasive fungal infection was diagnosed based on clinical symptoms, culture, radiological evidence and β -D glucan. Active fungal infection was treated with fluconazole, amphotericin B, flucytosine and micafungin. Risk factors both pre-and post-LDLT were analyzed. Candida albicans was the most frequently isolated species (70%). The risk factors identified by univariate analysis include the following four conditions: acute blood purification (plasma exchange with or without continuous hemodiafiltration), hepatic vein complications, renal failure and respiratory failure. By logistic regression analysis, hepatic vein complications and respiratory failure were identified as independent risk factors. The risk factors for invasive fungal infection of LDLT in Japan have not been well analyzed and this report will provide valuable information for the prevention of the fungal infection.invasive fungal infection; living donor liver transplantation; β -D glucan; risk factor; complication

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

“…The commonly used surveillance cultures lack the necessary sensitivity to detect IFI on time for efficient treatment. Accordingly, the level of serum β-D-glucan, a fungal cell wall component, has been used for rapid diagnosis [39, 40], and has been confirmed as efficient diagnostic test for early diagnosis of IFI [16, 40, 41]. The results of the present study support the sensitivity and specificity of β-D-glucan reported in the above studies.…”

“…The results of the present study support the sensitivity and specificity of β-D-glucan reported in the above studies. Interestingly, other groups used a different method for β-D-glucan measurement or used different cut-off values [16, 41]. Further studies are needed to determine the optimal cutoff value of serum β-D-glucan for LDLT patients.…”

“…Previous studies documented the causes of post-LDLT IFI that are mainly associated with the surgical procedure (e.g., prolonged surgery, biliary anastomosis, excessive blood loss, massive red blood cells transfusion, dialysis, reoperation, hepatic vein complications, respiratory failure, and re-transplantation), steroid-resistant rejection, poor renal function, and cytomegalovirus infection [10-15]. In these recipients, multivariate analysis identified several perioperative risk factors for IFI, including massive red blood cells transfusion, renal dialysis, reoperation, hepatic vein complications, respiratory failure, and the duration of preoperative ICU hospitalization [16-19]. However, these predictors cannot be used to identify patients at high risk of IFI after an apparently uneventful surgery.…”

Invasive Aspergillosis in Solid Organ Transplant Recipients

“…was useful for the diagnosis of invasive aspergillosis in living-donor liver allograft recipients in one study (49). A pan fungal PCR in the blood was shown to be helpful and preceded clinical signs of invasive fungal infections in renal transplant recipients by 27 days (50 Since this study, a number of reports of employing voriconazole for the treatment of invasive aspergillosis in SOT recipients have appeared in the literature.…”

Donor-Derived Infectious Complications and Disease Transmission

“…However, false-positive galactomannan tests have been documented in up to 13% of liver transplant recipients (Kwak et al, 2004), but the sensitivity of the assay for the diagnosis of invasive aspergillosis may be improved by testing bronchoalveolar lavage . The diagnosis of invasive aspergillosis using the 1-3, beta-d-glucan assay has not been fully defined, but one study has shown that the test was useful for the diagnosis of invasive aspergillosis in living-donor liver transplant recipients (Kawagishi et al, 2006). Currently, prophylaxis against invasive aspergillosis is not routinely recommended in all solid organ transplant recipients.…”