Risk Factors For Invasive Fungal Infections Complicating Orthotopic Liver Transplantation

Collins, L A; Samore, Matthew H.; Roberts, Margaret; Luzzati, Roberto; Jenkins, Roger L.; Lewis, W. David; Karchmer, A. W.

doi:10.1093/infdis/170.3.644

Cited by 276 publications

(212 citation statements)

References 22 publications

Supporting

Mentioning

194

Contrasting

Unclassified

Order By: Relevance

“…6 It is thus not surprising that other liver transplant studies have also found both OR time and volume of blood transfused associated with invasive infections caused by Candida organisms. 3,[7][8][9]11,12 Among our patients with definite invasive infection, there was a high incidence (42%) of localized peritoneal candidiasis. This is a common feature of Candida infection in liver transplant recipients 5 and is uncommon in other solid-organ transplant recipients and neutropenic patients.…”

Section: Discussionmentioning

confidence: 99%

“…3,[6][7][8][9][10][11][12] Factors reported to increase the risk for infection caused by Candida organisms include retransplantation, long operative (OR) time, days spent in the intensive care unit (ICU), use of preoperative antibiotics and steroids, duration of postoperative antibiotic therapy, high-dose steroids, urgent status, red blood cell (RBC) transfusion requirements, and concurrent bacterial infections. 3,[6][7][8][9][10] This study reviews the largest single-center pediatric experience with fungal infections after OLT to report the incidence and describe the spectrum of infection caused by Candida organisms in OLT, determine risk factors applicable to pediatric liver transplant recipients by using univariate and multivariate analysis, and comment on the therapeutic management and possible guidelines for antifungal prophylaxis in patients with infection caused by Candida organisms.…”

confidence: 99%

See 1 more Smart Citation

Candida infection in pediatric liver transplant recipients

et al. 1999

View full text Add to dashboard Cite

A retrospective review of 100 liver transplantations in 98 children was performed to determine the incidence of infection caused by Candida organism in these patients and to identify risk factors that may predispose to serious fungal infection. Thirty-one infections caused by Candida organisms developed during the initial 28 days posttransplantation: 19 were definite invasive infections (one deep site or one positive blood culture), 2 were probable invasive infections (three superficial sites), and 10 were urinary tract infections. Eleven of 19 patients had fungemia or a disseminated infection (two noncontiguous deep organs involved and/or positive blood cultures) and 8 of 19 had peritoneal candidiasis. Infection caused by Candida organisms was a contributing factor to mortality in 7 of 21 patients (case fatality rate of 33%) with invasive infection. Risk factors that were predictive for invasive infection by univariate analysis included the following: pretransplantation antibiotic therapy, length of transplant operation, transfusion requirement, number of days in the intensive care unit, number of days intubated, number of concurrent bacterial infections, number of antibiotics administered, number of laparotomies performed posttransplantation, retransplantation, hepatic artery thrombosis, bile leaks, and renal and respiratory failure. By logistic regression analysis, bile leak, hepatic artery thrombosis, preoperative steroid use, transfusion requirement, and the number of days intubated were identified as independent risk factors for invasive infection caused by Candida organisms. The use of prophylactic antifungal agents in high-risk patients may be important in reducing the serious morbidity and mortality associated with sepsis caused by Candida organisms in pediatric liver transplant recipients.

show abstract

Section: Discussionmentioning

confidence: 99%

Candida infection in pediatric liver transplant recipients

et al. 1999

View full text Add to dashboard Cite

show abstract

“…Episodes of aspergillosis that developed after day 100 were considered late cases. 5 Cytomegalovirus disease was defined according to standard clinical criteria. l7 Cytomegalovirus disease was defined as a compatible picture associated with direct tissue culture or histologic evidence of invasive cytomegalovirus disease, or when cytomegalovirus viral syndrome was present.…”

Section: Study Population: Definitionsmentioning

confidence: 99%

Risk factors for invasive aspergillosis in liver transplant recipients

et al. 2002

View full text Add to dashboard Cite

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.

show abstract

“…22 Risk factors for IFI after OLT can be identified and include a requirement for prolonged intensive care unit (ICU) treatment postoperatively. 4,6,23 We performed a prospective audit of a strategy in which Abelcet was administered to patients requiring ICU treatment for 5 days or greater post-OLT. This was achieved by intensive mycological surveillance of patients administered Abelcet (before and during prophylaxis) followed by in vitro fungal speciation and antifungal susceptibility testing.…”

mentioning

confidence: 99%

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Singhal

2000

Liver Transplantation

View full text Add to dashboard Cite

The purpose of this study is to prospectively evaluate a strategy in which prophylaxis with amphotericin B lipid complex at 3 different dosages was targeted to liver transplant recipients at high risk for the development of invasive fungal infection (IFI). High risk was defined as a postoperative requirement for prolonged (>5 days) intensive care unit (ICU) treatment. Consecutive high-risk patients were administered prophylaxis with amphotericin B lipid complex from day 5 after orthotopic liver transplantation (OLT) until ICU discharge or death. The first 10 eligible patients were administered 5 mg/kg/d, the next 10 patients were administered 2. I nvasive fungal infection (IFI) has a high mortality after orthotopic liver transplantation (OLT). In early studies, the incidence of IFI in this setting ranged from 18% to 42%, and the associated mortality rates were 50% to 78%. 1-6 Candida species accounted for the majority of infections, and many patients infected with Candida organisms survived. In contrast, infections caused by Aspergillus species were nearly always fatal. 2,3,6 We showed that in liver transplant recipients considered high risk for IFI, fluconazole prophylaxis reduced the incidence of invasive candidiasis 7 but was complicated by the emergence of fluconazole-resistant fungi and failed to prevent invasive aspergillosis. 8 A recent randomized, placebo-controlled trial of liver transplant recipients showed that prophylaxis with fluconazole was associated with a decrease in fungal colonization and fewer deaths related to IFI, but did not improve overall survival. 9 Amphotericin B formulations are the agents of choice for the treatment of infections caused by Aspergillus species. Concerns about toxicity related to conventional amphotericin B 10 have inhibited its use as antifungal prophylaxis in OLT. The development of new lipid-based formulations of amphotericin B that are less toxic than the conventional form of the drug has led to renewed interest in the potential prophylactic use of this agent. [11][12][13][14] In 1 study, prophylaxis with liposomal amphotericin B (AmBisome; Nexstar, San Dimas, CA) at 1 mg/kg/d from the time of OLT reduced the incidence of IFI compared with placebo. 15 However, another group observed systemic mycosis in 4 of 58 liver transplant recipients treated according to a similar prophylactic schedule with AmBisome. 16 Amphotericin B lipid complex (Abelcet; The Liposome Co Ltd, London, England) is a lipid formulation with a high amphotericin B-lipid ratio (1:1), 17 and pharmacokinetic studies indicate that this formulation achieves lower peak plasma concentrations but greater tissue levels than the other lipid formulations of amphotericin B. 18 Furthermore, the in vitro activity of Abelcet against isolates of both Aspergillus and Candida organisms has recently been shown to be similar to that achieved by conventional amphotericin B but significantly greater than that achieved by AmBisome. 19 A randomized, prospective multicenter trial confirmed that Abelcet was as effective as...

show abstract

Risk Factors For Invasive Fungal Infections Complicating Orthotopic Liver Transplantation

Cited by 276 publications

References 22 publications

Candida infection in pediatric liver transplant recipients

Candida infection in pediatric liver transplant recipients

Risk factors for invasive aspergillosis in liver transplant recipients

Targeted Prophylaxis With Amphotericin B Lipid Complex in Liver Transplantation

Contact Info

Product

Resources

About