INVASIVE ASPERGILLOSIS IN LIVER TRANSPLANT RECIPIENTS IN THE 1990s

Singh, Nina; Arnow, Paul M.; Bonham, Andrew; Dominguez, Edward A.; Paterson, David L.; Pankey, George A.; Wagener, Marilyn M.; Yu, Victor L.

doi:10.1097/00007890-199709150-00009

Cited by 162 publications

(157 citation statements)

References 16 publications

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“…8,9,15 A retrospective case-control study was performed to describe the global risk factors for AspergiLlus infections among liver transplant recipients and to evaluate the impact of RrpergilluJ antigenemia as a marker for patients at special risk of developing aspergillosis. A secondary analysis was focused to assess the frequency of late aspergillosis and to identify risk factors associated with the disease in this period.…”

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confidence: 99%

Risk factors for invasive aspergillosis in liver transplant recipients

et al. 2002

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Aspergillosis is a potential, severe, and usually early complication of liver transplantation. New promising strategies, such as detecting AspergiUzrs antigenemia, have been used for the diagnosis of aspergillosis in immunosuppressed patients, but the impact in solid organ transplantation is not well known. A case-control study in 260 adults who underwent liver transplantation from January 1994 to June 2000 was performed. A case was defined as any liver transplant recipient with a proven or probable diagnosis of invasive aspergillosis. Controls were defined as a liver transplant recipient without aspergillosis infection with a survival longer than two months after transplantation. Clinical and analytical variables, including Aspergi22u.s antigenemia, were compared. A special analysis was performed in patients in whom late aspergillosis developed (after day 100 posttransplantation). Among 260 patients, invasive aspergillosis developed in 15 (5.6%). Median time from transplantation to aspergillosis in 13 patients with sufficient data for analysis was 126 days (range, 22 to 1117). Seven (54%) developed the infection after day 100 posttransplantation. Thirty-eight patients were used as controls. Antigenemia was available in nine of 13 cases and in 33 of 38 controls. By multivariate analysis, retransplantation (OR, 29.9 [95% CI, 2.1 to 425.1]), dialysis requirements after transplantation (OR, 24.5 [95% CI, 1.25 to 354]), and the presence ofAspqz.2-2u.s antigenemia in serum at any time point after transplantation (OR, 50.0 [95% CI, 3.56 to 6501) were independently associated to aspergillosis. In the subgroup of patients that developed late aspergillosis, cytomegalovirus infection (OR, 6.7 [95% CI, 1.0 to 42.51) was the only independent factor associated. Hepatic and renal dysfunction predispose to Aspergilltcs infection in liver transplant recipients. Cytomegalovirus infection and increased immunosuppression favor invasive aspergillosis during the late posttransplantation period. Aspergillus antigenemia seems to be a good predictor of invasive aspergillosis.

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Risk factors for invasive aspergillosis in liver transplant recipients

et al. 2002

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“…53 In a case series of 26 patients with invasive aspergillosis after orthotopic liver transplantation, infection occurred a median of approximately 2.5 weeks after transplantation with a mortality rate of 92%. 64 The identification of potential risk factors may reduce the morbidity and mortality rates of invasive aspergillosis are necessary but reports have been variable and conflicting in some instances with regards to the importance of immunosuppression. [64][65][66] Suspected risk factors for invasive aspergillosis including: renal insufficiency, the need for renal replacement therapy post-transplantation, retransplantation, CMV infection, repeated bacterial infections, preoperative ICU stay, preoperative steroid administration, fulminant hepatic failure, the presence of Aspergillus antigenemia, and the use of OKT3 monoclonal antibody.…”

Section: Candidamentioning

confidence: 99%

“…64 The identification of potential risk factors may reduce the morbidity and mortality rates of invasive aspergillosis are necessary but reports have been variable and conflicting in some instances with regards to the importance of immunosuppression. [64][65][66] Suspected risk factors for invasive aspergillosis including: renal insufficiency, the need for renal replacement therapy post-transplantation, retransplantation, CMV infection, repeated bacterial infections, preoperative ICU stay, preoperative steroid administration, fulminant hepatic failure, the presence of Aspergillus antigenemia, and the use of OKT3 monoclonal antibody. 65,67,68 Antifungal therapy should be instituted upon any clinical suspicion of aspergillosis without waiting for microbiology results.…”

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confidence: 99%

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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“…1 Infections caused by Aspergillus species in liver transplant recipients are notable for their early occurrence. The median time to onset after transplantation was 17 days in one study 2 and 16 days in another. 3 Virtually all patients who have developed invasive aspergillosis have never left the intensive care unit after liver transplantation surgery.…”

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confidence: 92%

“…3 Virtually all patients who have developed invasive aspergillosis have never left the intensive care unit after liver transplantation surgery. 2,3 Of central nervous system lesions of infectious causes occurring within 30 days of liver transplantation, 75% were caused by Aspergillus species. 4 The study by Fortun et al 5 is important for two reasons.…”

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confidence: 99%