Fungal complications afterCandidapreservation fluid contamination in liver transplant recipients

Abstract

Summary Donor‐derived fungal infections can be associated with severe complications in transplant recipients. Donor‐derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5‐year (2008–2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida‐related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty‐two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7–37 days. Eight patients developed yeast‐related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1‐year mortality rate among patients after a yeast‐related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow‐up may enable early recognition of the arterial complications associated with PF contamination by Candida.

Candidemia in solid organ transplant recipients in Spain: Epidemiological trends and determinants of outcome

“…Although contamination of the preservation fluid with Candida spp. is uncommon, the occurrence of serious postoperative complications with high associated mortality (such as mycotic arteritis) has been reported, particularly among kidney transplant recipients …”

A Silent and Very Early Post-Liver Transplant Death by Candida Arteritis

“…In a review of 25 graft-site candidiasis cases after kidney transplantation, the majority (14 cases) were renal arteritis [5]. Graft site candidiasis is also associated with PF culture positivity [3,[5][6][7]. In a review of 28 liver transplant patients with yeast culture-positive PF, 28.6% presented with graft site arteritis [7].…”

“…Candida arteritis is a devastating form of candidiasis. In SOT recipients this generally occurs as anastomotic site infection of graft vessels [3][4][5][6][7], often leading to rupture or mycotic aneurysm, and subsequent graft loss. Here we report a case of invasive Candida arteritis leading to massive abdominal hemorrhage and death at postoperative day (POD) 10 without any clinical suspicion.…”

Risk factors for early invasive fungal infections in paediatric liver transplant recipients

“…Invasive candidiasis can originate from either an endogenous source, usually the skin or gut or from an exogenous source, such as the donated organ. Transplanted organs may act as reservoirs for potentially pathogenic fungi or preservation fluid …”

“…Transplanted organs may act as reservoirs for potentially pathogenic fungi or preservation fluid. [24][25][26] Multiple risk factors for invasive candidiasis have been detected in transplanted recipients, particularly liver transplant individuals. In accordance with previously published studies in adults, our univariate analysis of paediatric patients identified transfusion requirements, surgical complications, pulse corticosteroids treatment, prolonged antibiotic use and an indwelling vascular catheter as significant risk factors for IFIs.…”