Risk Factors of Invasive Candida and Non-Candida Fungal Infections After Liver Transplantation1

Abstract

Fungal infections are associated with a high mortality rate after liver transplantation. To describe risk factors for fungal infections, 405 consecutive liver transplant recipients were analyzed. Forty-five patients (11%) developed invasive fungal infection. Median posttransplantation time to the first episode was 60 days. Pathogens were Candida species (spp) (n=24, 53%), Cryptococcus neoformans (n=10, 22%), Aspergillus spp (n=6, 13%), Rhizopus spp (n=l), and others (n=4). Presentations of infection included disseminated (n=9), intra-abdominal (n=9), esophageal (n=9), lung (n=8), blood (n=6), and central nervous system infections (n=3), and sinusitis with esophagitis (n=1). Eighteen patients (40%) with invasive fungal infection died, and 13 (72%) of these deaths were attributable to fungi. Mortality in the nonfungal infection group was 12%. Univariate analysis identified separate risk factors for Candida (intra-abdominal bleeding), Aspergillus (fulminant hepatitis), and cryptococcal (symptomatic cytomegalovirus infection) infections. In both univariate and multivariate analyses, a high intratransplant transfusion requirement and posttransplant bacterial infection were identified as significant risk factors for all types of fungal infection. The risk factor analysis reported here suggests that different pathogenic processes lead to Candida and non-Candida infection in liver transplant recipients. Their identification should prompt specific prophylactic measures to reduce morbidity and mortality in this population.

Epidemiology of fungal infections in liver transplant recipients: a six-year study of a large Brazilian liver transplantation centre

“…Similar incidences were previously described in low risk patients, while higher rates are found in patients with many risk factors (Patel et al 1996, Rabkin et al 2000, Fung 2002, Husain et al 2003. In addition to a decreased need in intraoperative transfusion and shorter post-transplantation Intensive Care Unit (ICU) stay, a low proportion of patients underwent choledochojejunostomy or had CMV infection.…”

Hepatobiliary Quiz Answers—19 (2016)

“…Need of hemodialysis post-operatively, prophylaxis for spontaneous bacterial peritonitis, and retransplantation are important risk factors for invasive candidiasis. 61,62 Cytomegalovirus (CMV) infections are common in post-OLT patients. Patients who develop CMV disease are at a higher risk for invasive candidal infections.…”

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.…”