Changes in the spectrum and risk factors for invasive candidiasis in liver transplant recipients: prospective, multicenter, case-controlled study1

Husain, Shahid; Tollemar, J; Dominguez, Edward A.; Baumgarten, Katherine; Humar, Atul; Paterson, David L.; Wagener, Marilyn M.; Kusne, Shimon; Singh, Nina

doi:10.1097/01.tp.0000065178.93741.72

Cited by 182 publications

(191 citation statements)

References 28 publications

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“…The gastrointestinal tract is often colonized with candidal species and is the most likely portal of entry, via translocation through the intestinal walls to extraluminal locations or due to spillage from bowel anastomosis. 59,60 Candida may cause intra-abdominal abscesses, peritonitis, or may disseminate hematogenously to other organs. Need of hemodialysis post-operatively, prophylaxis for spontaneous bacterial peritonitis, and retransplantation are important risk factors for invasive candidiasis.…”

Section: Correct Answers: a C And Dmentioning

confidence: 99%

Hepatobiliary Quiz Answers—19 (2016)

Rathi

Dhiman

2016

Journal of Clinical and Experimental Hepatology

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Section: Correct Answers: a C And Dmentioning

confidence: 99%

Hepatobiliary Quiz Answers—19 (2016)

Rathi

Dhiman

2016

Journal of Clinical and Experimental Hepatology

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“…Candida albicans is the most common isolated species followed by Candida glabrata and Candida tropicalis. 43,44 The gastrointestinal tract is often colonized with candidal species and those with advanced liver disease/cirrhosis may be predisposed to supercolonization. One study of potential orthotopic liver transplant recipients identified colonization with candida species in all subjects at varying locations in the alimentary canal.…”

Section: Candidamentioning

confidence: 99%

“…[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. 48 CMV disease is a clear risk factor for all types of invasive candidal infections, and effective prophylaxis of patients at high risk for CMV disease, such as those who are CMV D+/ RÀ (donor positive, recipient negative), has been shown to significantly decrease the incidence of invasive Candida infection in the absence of specific anti-Candida prophylaxis.…”

Section: Candidamentioning

confidence: 99%

“…92,93 CMV is thought to be a risk factor for invasive fungal and bacterial infections in liver recipients as aforementioned. 44,94,95 CMV can also interact with other viruses and may accelerate hepatitis C virus pathogenesis. 96 In addition, the activation of the other herpesviruses human herpesvirus-6 and Epstein-Barr virus has been reported with CMV.…”

Section: Cytomegalovirusmentioning

confidence: 99%

See 1 more Smart Citation

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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“…Im Zusammenhang mit systemischen Mykosen wurden für Transplantationspatienten als Risikofaktoren eine präoperative Kolonisation mit Candida, ein pulmonaler Aspergillus-Nachweis (Lungentransplantation), eine Retransplantation, eine lange Operationsdauer (>5 h) mit hohem Blutverlust/ Massivtransfusion [19,28], ein langer Intensivaufenthalt zusammen mit der Notwendigkeit der Anlage invasiver Katheter (Z. B. zentraler Venen-, Dialysekatheter, Drainagen, Stents; [10,18,20,28]), der Einsatz von Breitspektrumantibiotika, ein Nierenversagen (ggf. Hämofiltration bzw.…”

Section: Grundlagenunclassified