Trends in Risk Profiles for and Mortality Associated with Invasive Aspergillosis among Liver Transplant Recipients

Abstract

To discern whether the characteristics and outcome of invasive aspergillosis in liver transplant recipients have evolved during the past decade, 26 patients who underwent transplantation during 1990-1995 (known as "the earlier cohort") were compared with 20 patients who underwent transplantation during 1998-2001 (known as "the later cohort"). Twenty-three percent of the Aspergillus infections in the earlier cohort occurred у90 days after transplantation, compared with 55% of such infections in the later cohort ( ). The earlier cohort P p .026 was significantly more likely to have disseminated infection ( ) and central nervous system (CNS) in-P p .034 volvement ( ) than was the later cohort. The mortality rate was significantly higher for the earlier cohort P p .0004 (92%) than for the later cohort (60%;). Only disseminated infection (not the year of transplantation) P p .012 approached statistical significance as an independent predictor of outcome. In the current era, invasive aspergillosis occurs later in the posttransplantation period, is less likely to be associated with CNS infection, and is associated with a lower mortality rate, compared with invasive aspergillosis in the early 1990s.Invasive aspergillosis has long been recognized as one of the most significant opportunistic fungal infections in liver transplant recipients [1][2][3][4]. The frequency of invasive aspergillosis among liver transplant recipients ranges from 1% to 6% [2]. However, the mortality rate for these patients exceeds 90% [1,5]; an estimated 16.9% of all deaths that have occurred among liver

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“…1 Renal replacement therapies, including hemodialysis, increase risk by about 15-to 25-fold. 3,4 In our case, the patient had acute renal failure within the first week posttransplant and underwent hemodialysis, which increased the risk for invasive aspergillosis, in accordance with risk factors shown in the literature.…”

“…5,6 Recent cohort studies have shown that there is a tendency for invasive aspergillosis to develop at late onset, with median time found to be 60 days posttransplant. 3 The shift of infection incidence in later stages might be due to improved surgical techniques, better follow-up, and decreased incidence of risk factors, such as cytomegalovirus infection during the early posttransplant period. Our patient had pulmonary symptoms at day 26 posttransplant, and a positive galactomannan at day 32 when the antifungal treatment was started.…”

Caspofungin nach Transplantation solider Organe in Deutschland

“…Systemische Pilzinfektionen gehören zu den klassischen opportunistischen Erkrankungen bei transplantierten Personen, mit hohen Morbiditäts-und Letalitätsraten [23,24,26]. Die Inzidenz von Pilzinfektionen variiert je nach Quelle und transplantiertem Organ deutlich [16].…”

Echinocandins for antifungal prophylaxis in liver transplant recipients: Advance in the field or variation on a theme?

“…Patients with fulminant hepatic failure, RRT, and retransplantation are at particular risk for IA and may be considered for prophylaxis with an agent with activity against filamentous fungi (echinocandins, voriconazole, or amphotericin). (11,12) Abbreviations: HR-LTR, high-risk liver transplant recipient; IA, invasive aspergillosis; IFI, invasive fungal infection; RCT, randomized controlled trial; RRT, renal replacement therapy; TENPIN, Liver Transplant European Study Into the Prevention of Fungal Infection.…”