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Published on: November 7, 2020
Trends in invasive fungal infections in liver transplant recipients: correlation with evolution in transplantation
Nina Singh1, Marilyn M Wagener, Ignazio R Marino
1VA Medical Center, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240, USA.
Background:
The incidence of invasive fungal infections, particularly invasive candidiasis, after liver transplantation is strongly influenced by surgical factors and technical complexity of the surgery. We assessed the temporal trends in invasive fungal infections in the context of evolution in liver transplantation practices, technical developments, and other risk factors.
Methods:
Demographic and clinical characteristics of the patients, transplantation-related variables, and rates of infection were longitudinally analyzed over the last 10 years in 190 consecutive liver transplant recipients at our institution. Trends for categorical data were evaluated using the Cochran-Armitage trend test and for continuous variables using analysis of variance with linear contrast.
Results:
A decrease in the length of operation (P=0.03), intraoperative transfusion requirements (P=0.0001), cold ischemic time (P<0.0001), use of roux-en-Y biliary anastomosis (P=0.0015), rate of biopsy proven rejection (P<0.0001), and retransplantation (P=0.056) was documented over the successive years. A significant decline in Child-Pugh score (P=0.02) and in the proportion of patients transplanted as UNOS 2a occurred (P=0.0001). Although the incidence of cytomegalovirus infection remained unchanged, a significant increase in the frequency of primary cytomegalovirus infection (P=0.045), and a decrease in cytomegalovirus disease (P=0.0006) was documented. Over the same time period, a significant decrease in the incidence of invasive candidiasis (P=0.015), and an insignificant increase in the rate of invasive aspergillosis (P=0.20) occurred.
Conclusion:
Notable technical developments in liver transplantation practices and risk profiles of patients have occurred over the decade. These variables may have a role in influencing the evolving trends in invasive fungal infections in liver transplant recipients.
Insights
Liver transplant practices have evolved, leading to fewer invasive fungal infections, particularly candidiasis. Technical advancements and changes in patient risk profiles may explain these trends in transplant recipients.
Area of Science:
- Hepatology and Transplant Surgery
- Infectious Diseases
- Medical Technology and Innovation
Background:
- Invasive fungal infections (IFIs) are a significant concern after liver transplantation, influenced by surgical complexity.
- Assessing temporal trends of IFIs is crucial given evolving liver transplant practices and risk factors.
Purpose of the Study:
- To evaluate the trends of invasive fungal infections in liver transplant recipients over a 10-year period.
- To correlate these trends with advancements in surgical techniques and changes in patient demographics and risk profiles.
Main Methods:
- Longitudinal analysis of 190 liver transplant recipients over 10 years.
- Statistical evaluation of demographic, clinical, and transplantation-related variables.
- Trend analysis using Cochran-Armitage test for categorical and ANOVA for continuous data.
Main Results:
- Significant decreases observed in operation length, transfusion needs, cold ischemic time, and use of Roux-en-Y anastomosis.
- Reduced patient severity (Child-Pugh score) and a shift in UNOS status for transplant recipients.
- Decreased incidence of invasive candidiasis (P=0.015), while invasive aspergillosis showed no significant change (P=0.20).
Conclusions:
- Liver transplantation has seen significant technical improvements and shifts in patient risk profiles over the past decade.
- These evolving factors likely influence the observed trends in invasive fungal infections among liver transplant recipients.
- The reduction in invasive candidiasis incidence highlights the potential impact of surgical and patient management advancements.
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