Risk factors for systemic fungal infections in liver transplant recipients

• Published in: European journal of clinical microbiology & infectious diseases Vol. 14; no. 5; pp. 375 - 382
• Main Authors: BRIEGEL, J, FORST, H, PETER, K, SPILL, B, HAAS, A, GRABEIN, B, HALLER, M, KILGER, E, JAUCH, K. W, MAAG, K, RUCKDESCHEL, G
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-05-1995
• Subjects: Adult; Amphotericin B - administration & dosage; Amphotericin B - therapeutic use; Analysis of Variance; Antifungal Agents - administration & dosage; Antifungal Agents - therapeutic use; Aspergillus; Biological and medical sciences; Candida; Female; Fungemia - drug therapy; Fungemia - etiology; Humans; Incidence; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Logistic Models; Male; Medical sciences; Middle Aged; Mycoses - drug therapy; Mycoses - etiology; Mycoses - prevention & control; Opportunistic Infections - drug therapy; Opportunistic Infections - microbiology; Opportunistic Infections - prevention & control; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Infection; Human; Prevention; Mycosis; Surgery; Liver; Risk factor; Digestive diseases; Hepatic disease; Disseminated; Homotransplantation
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/bf02114892

The risk factors for systemic fungal infections were analysed retrospectively in 186 orthotopic liver transplant procedures performed in 152 patients between June 1985 and January 1993. The total incidence of systemic fungal infections was 16.5% (25/152). The incidence of disseminated candidiasis, aspergillosis, and combined candidiasis and aspergillosis was 6.5% (n = 10), 7.2% (n = 11) and 2.6% (n = 4), respectively. Mortality associated with systemic fungal infections was 80% (20 of 25 patients). There were ten cases of disseminated candidiasis, with 4 patients surviving, and 11 cases of invasive aspergillosis, with 1 patient surviving. All patients with combined systemic fungal infection died. To identify perioperative risk factors, 39 variables were used to compare patients with systemic fungal infections versus those without fungal infections. Fourteen variables were significantly associated with systemic fungal infections by univariate analysis. A consecutive logistic regression analysis revealed that the amount of fresh frozen plasma transfused due to poor initial function of the allograft and acute renal failure requiring hemofiltration were independently significant risk factors for systemic fungal infections. There was no statistical correlation between systemic fungal infections and the underlying liver disease, previous long-term corticosteroids and the postoperative immunosuppressive therapy. Risk factors identified in this study should be considered in the postoperative care of the individual liver transplant recipient. In our study a poor initial function of the hepatic allograft substantially increased the risk of systemic fungal infection.