Fungal infections in liver transplant recipients

Abstract

A retrospective analysis of 462 consecutive orthotopic liver transplantations was undertaken to evaluate incidence, risk factors, clinical course, and outcome of fungal infections. Infections involving Aspergillus (6 cases), Candida (5 cases), Mucor (1 case), and Cryptococcus (1 case) were observed in 2.8% (13/462) of our patients. Twelve of the 13 episodes developed during the first 2 postoperative months. None of the potential risk factors for fungal infections described by other authors (i.e., age, rejection treatment, dialysis, mechanical ventilation, graft failure, long operation time, second transplant, serious non-fungal infection) correlated significantly with the episodes in our patients. However, in patients who exhibited three or more of these potential risk factors the incidence of fungal infections was elevated (P < 0.001). Six of seven exogenous infections (Aspergillus, Mucor) began before July 1991 when our department moved from Charlottenburg to Wedding, thus indicating that the incidence of these infections is highly influenced by exposure (P = 0.01). Exposure prophylaxis should therefore by meticulously followed, particularly when severely compromised patients are involved, in order to prevent exogenous infections (i.e., Aspergillus/Mucor). Infections involving such patients are combined with a very high mortality (57%). We observed Candida infection as a pathological overgrowth of physiological oropharynx flora into the esophagus and/or trachea in five patients. In each case treatment led to full recovery.

Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome®) after liver transplantation

“…Grauhan et al . [19] reported 13 patients with fungal infections after liver transplantation. They found no correlation between fungal infections and potential risk factors, such as rejection treatment, dialysis, mechanical ventilation, graft failure, long operation time, second transplant, serious non‐fungal infection.…”

Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000)

“…The rates of severe fungal infections vary in other studies (11,13,25,27) , but all agreed that mortality rate is high. Possibly their frequency is diminishing (13,29) , but PATEL et al (20) also points to the difficulties in diagnosis, which means that this may be underestimated.…”

Risk factors for fungal infection in paediatric liver transplant recipients

“…The proportion of FI in LT caused by Candida spp. was reported to be 87% in Boston (7), 78% in Pittsburgh (24), and approximately 50% in other centres (4, 13, 25). Candida spp.…”