Surveillance and treatment of liver transplant recipients for candidiasis and aspergillosis

Abstract

Between June 1988 and May 1991 88 orthotopic liver transplants and 1 liver and pancreas transplant were performed at the Liver Transplantation Department of the Ospedale Maggiore of Milan. All the patients underwent mycological surveillance and received antifungal prophylaxis with oral amphotericin B (6000 mg/day) or oral or intravenous fluconazole (200 mg/day) from the time of their transplant. The incidence of Candida colonization was 67%. Fluconazole was superior to oral amphotericin B in the treatment of C. albicans colonization (9/9 vs 6/15), but less effective in the treatment of colonization by other Candida spp. (0/3 vs 3/3). Deep-seated candidiasis developed in 5 patients, caused by C. albicans in 4 cases and C. krusei in 1. C. albicans infection resolved rapidly with fluconazole in 2 subjects, with intravenous amphotericin B alone in 1, and with amphotericin B plus flucytosine in the other. On the contrary, C. krusei infection did not respond to treatment with amphotericin B combined with flucytosine. Aspergillosis was diagnosed in 11 patients, of whom 4 died from invasive aspergillosis, despite 15 and 26 days of amphotericin B treatment in 2. In another patient invasive aspergillosis, diagnosed a few hours before retransplantation, improved with liposomal amphotericin B, but this man died from cytomegalovirus infection one month later. Aspergillosis was eradicated by itraconazole in 4 other patients and by topical amphotericin B in 2 whose infection was localized to surgical wound.

Outcome after living donor liver transplantation: A comprehensive retrospective analysis of the risk factors for morbidity, mortality and graft failure in a tertiary care center

“…The incidence of invasive fungal infection was reported to be lower than in other centers which reported a range between 4.0% to 48.0% [130][131][132]. Similar incidence was reported by other authors [131,133]. Our results denoted that the appearance of fungal infection carries a bad prognosis.…”

“…In addition, clinical manifestations of graft ischemia or graft rejection can mimic those of infection. The incidence of invasive fungal infection was reported to be lower than in other centers which reported a range between 4.0% to 48.0% [130][131][132]. Similar incidence was reported by other authors [131,133].…”

Guidelines for the investigation of invasive fungal infections in haematological malignancy and solid organ transplantation

“…Invasive fungal infections are less frequent in solid organ transplant recipients and vary according to the type of transplant (Table 1). Thus, they occur in less than 5% of renal transplant recipients (9)(10)(11), in 10% of heart transplant recipients (12,13), in 15 to 20% of heart-lung transplant recipients (14,15), and in more than 20% of liver transplant patients (16)(17)(18)(19)(20).…”

Antigenic Properties and Processing Requirements of 65-Kilodalton Mannoprotein, a Major Antigen Target of Anti-CandidaHuman T-Cell Response, as Disclosed by Specific Human T-Cell Clones

“…Mucosal candidiasis is frequent in immunocompromised patients, especially those infected by the human immunodeficiency virus or those affected by idiopathic CD4 ϩ T lymphocytopenia (6,15,34,44), while deep-seated candidiasis is highly prevalent in neutropenic, bone marrow transplant patients (28,30,53). Finally, a large incidence of vaginal infection by Candida is recorded in otherwise healthy women of premenopausal age (24).…”