Graphical abstract

Zygomycosis is characterized by tissue invasion with broad, non-septate hyphae of species such as Rhizopus, Rhizomucor, Lichtheimia (Absidia) and Basidiobolus. Basidiobolus ranarum usually causes subcutaneous infection, and gastrointestinal manifestations in immunocompetent patients have rarely been reported. It is difficult to diagnose gastrointestinal basidiobolomycosis because of the non-specific clinical presentation and the absence of a definite risk factor. This study identified 14 cases of gastrointestinal basidiobolomycosis, all of which were diagnosed after surgery by characteristic histopathological findings. Diagnosis of this disease requires a high index of suspicion in patients presenting with abdominal symptoms, fever, gastrointestinal mass and eosinophilia accompanied by a high erythrocyte sedimentation rate.

No abstract

The aim of this study was to analyze longterm patient and graft survival after liver transplantation for autoimmune hepatitis (AIH‐LT) from the prospective multicenter European Liver Transplant Registry. Patient and liver graft survival between 1998 and 2017 were analyzed. Patients after AIH‐LT (n = 2515) were compared with patients receiving LT for primary biliary cholangitis (PBC‐LT; n = 3733), primary sclerosing cholangitis (PSC‐LT; n = 5155), and alcohol‐related cirrhosis (AC‐LT; n = 19,567). After AIH‐LT, patient survival was 79.4%, 70.8%, and 60.3% and graft survival was 73.2%, 63.4%, and 50.9% after 5, 10, and 15 years of follow‐up. Overall patient survival was similar to patients after AC‐LT (P = 0.44), but worse than after PBC‐LT (hazard ratio [HR], 1.48; P < 0.001) and PSC‐LT (HR, 1.19; P = 0.002). AIH‐LT patients were at increased risk for death (HR, 1.37‐1.84; P < 0.001) and graft loss (HR, 1.35‐1.80; P < 0.001) from infections compared with all other groups and had a particularly increased risk for lethal fungal infections (HR, 3.38‐4.20; P ≤ 0.004). Excluding patients who died within 90 days after LT, risk of death after AIH‐LT was superior compared with AC‐LT (HR, 0.84; P = 0.004), worse compared with PBC‐LT (HR, 1.38; P < 0.001) and similar compared with PSC‐LT (P = 0.93). Autoimmune hepatitis (AIH) patients with living donor liver transplantation (LDLT) showed reduced survival compared with patients receiving donation after brain death (HR, 1.96; P < 0.001). In AIH‐LT patients, overall survival is inferior to PBC‐LT and PSC‐LT. The high risk of death after AIH‐LT is caused mainly by early fatal infections, including fungal infections. Patients with LDLT for AIH show reduced survival.