Risk factors for systemic fungal infections in liver transplant recipients

Abstract

The risk factors for systemic fungal infections were analysed retrospectively in 186 orthotopic liver transplant procedures performed in 152 patients between June 1985 and January 1993. The total incidence of systemic fungal infections was 16.5% (25/152). The incidence of disseminated candidiasis, aspergillosis, and combined candidiasis and aspergillosis was 6.5% (n = 10), 7.2% (n = 11) and 2.6% (n = 4), respectively. Mortality associated with systemic fungal infections was 80% (20 of 25 patients). There were ten cases of disseminated candidiasis, with 4 patients surviving, and 11 cases of invasive aspergillosis, with 1 patient surviving. All patients with combined systemic fungal infection died. To identify perioperative risk factors, 39 variables were used to compare patients with systemic fungal infections versus those without fungal infections. Fourteen variables were significantly associated with systemic fungal infections by univariate analysis. A consecutive logistic regression analysis revealed that the amount of fresh frozen plasma transfused due to poor initial function of the allograft and acute renal failure requiring hemofiltration were independently significant risk factors for systemic fungal infections. There was no statistical correlation between systemic fungal infections and the underlying liver disease, previous long-term corticosteroids and the postoperative immunosuppressive therapy. Risk factors identified in this study should be considered in the postoperative care of the individual liver transplant recipient. In our study a poor initial function of the hepatic allograft substantially increased the risk of systemic fungal infection.

Invasive Aspergillosis in Solid Organ Transplant Recipients

“…Retransplantation confers 30- (3,10). Most Invasive fungal infections in these high-risk patients occur within the first month posttransplant; the median time to onset of invasive aspergillosis after renal replacement therapy and retransplantation was 13 and 28 days, respectively in one study (8,12) (6)(7)(8)(13)(14)(15); Table 2). …”

“…Invasive aspergillosis occurs in [1][2][3][4][5][6][7][8][9].2% of the liver transplant recipients (1,(4)(5)(6)(7)(8). A number of well-characterized risk factors have been shown to portend a high risk of invasive aspergillosis after liver transplantation.…”

AspergillusInfections in Transplant Recipients

“…Invasive aspergillosis has been reported in 1 to 8% of liver transplant recipients (36,37,47,58,85,160,214,235,314). Aspergillus infections in these patients typically occur in the early posttransplant period.…”

Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000)

“…With univariate analysis the first four factors were all significant risk factors, but with multivariate analysis only diabetes and biliary stenosis were. Again, all these risk factors have figured in other studies (2,9,10,26) . Diabetes appeared as the strongest risk factor in our analysis, but this finding may be partly related to few diabetic patients (only four) in our series.…”