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Published on: November 7, 2020
Aspergillosis in liver transplant recipients: successful treatment and improved survival using a multistep approach
Andrea Duchini1, David C Redfield, John G McHutchison
1Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, Calif 92037, USA.
Background:
Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.
Methods:
We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center.
Results:
A diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary involvement; 1 presented with an inguinal mass. Time from transplant to infection ranged from 1 week to 34 months. Treatment included surgical intervention and medical treatment. All patients infected with Aspergillus fumigatus were treated with a sequential protocol of lipid complex amphotericin followed by itraconazole. The major side effect of treatment was worsening renal function. One patient died of intracranial hemorrhage during treatment.
Conclusion:
Successful treatment of aspergillosis in liver transplant recipients should include early diagnosis, sequential medical treatment with lipid amphotericin B and itraconazole, and surgical intervention for invasive disease.
Insights
Invasive aspergillosis is a serious risk for liver transplant recipients. Early diagnosis and sequential treatment with lipid amphotericin B and itraconazole, alongside surgery, improve outcomes.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Clinical Outcomes Research
Background:
- Invasive aspergillosis presents a critical threat to liver transplant recipients, carrying a mortality rate exceeding 90%.
- Effective treatment strategies for this patient group remain challenging due to the lack of uniformly effective agents.
Purpose of the Study:
- To evaluate the outcomes of invasive aspergillosis in liver transplant recipients.
- To identify key components for successful treatment protocols.
Main Methods:
- Retrospective review of fungal cultures from 200 liver transplant patients (1996-1999).
- Analysis of patient demographics, infection sites, treatment regimens, and outcomes.
Main Results:
- Aspergillosis diagnosed in 6 patients, primarily with pulmonary involvement (5/6).
- Infections occurred between 1 week and 34 months post-transplant.
- Sequential treatment with lipid-complex amphotericin B followed by itraconazole, combined with surgical intervention, was employed. Worsening renal function was a noted side effect.
Conclusions:
- Successful management necessitates early diagnosis of invasive aspergillosis in liver transplant recipients.
- A sequential medical approach utilizing lipid amphotericin B and itraconazole is recommended.
- Surgical intervention is crucial for invasive disease management.
