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[Invasive mycoses in liver transplantation]
J Romanyk1, A del Palacio, C Fiaño
1Servicio de Microbiología, Hospital 12 de Octubre, Madrid.
Abstract:
Seventy three adults underwent orthotopic liver transplantations between February 1987 and November 1989 and were followed (54 retrospectively and 19 in a prospective study) with the aim of establishing the incidence of deep mycoses (3 disseminated candidiasis due to C. albicans, 1 invasive aspergillosis due to A. fumigatus and 1 invasive pulmonary aspergillosis due to A. niger and A. fumigatus). 4/5 of these infections occurred in the first month after transplantation. All the patients were associated with the following clinical risk factors: previous use of wide spectrum antibiotics (5/5); more than 1 abdominal laparotomy (4/5), due to primary failure of the graft (3/4) and thrombosis of the hepatic artery (1/4). Two of the three patients [corrected] with invasive candidiasis had previous episodes of documented fungemia. 24 patients of the group who didn't show MIP had some risk factor which in all of them was the previous use of high dose steroids and/or of wide spectrum antibiotics, in addition to the used in surgical prophylaxis. In our series, the one risk factor associated with MIP was more than one previous laparotomy (p less than 0.001). Other significant associated infections were 3 bacterial sepsis (2 due to Enterococcus faecalis and 1 due to Staphylococcus epidermidis) and one viral (Cytomegalovirus viremia). The mortality rate was 100%, however the cause of death was multifactorial.
Insights
Deep fungal infections are a significant risk following liver transplantation, often occurring within the first month. Multiple abdominal surgeries and antibiotic use are key risk factors for these severe post-transplant complications.
Area of Science:
- Medical Mycology
- Transplantation Surgery
- Infectious Diseases
Background:
- Orthotopic liver transplantation is a complex procedure with potential for serious complications.
- Deep mycoses, fungal infections affecting internal organs, pose a significant threat to transplant recipients.
- Understanding the incidence and risk factors for these infections is crucial for improving patient outcomes.
Observation:
- A study of 73 liver transplant recipients identified 5 cases of deep mycoses within the first month post-transplantation.
- Infections included candidiasis, invasive aspergillosis, and invasive pulmonary aspergillosis.
- Key clinical risk factors identified were previous broad-spectrum antibiotic use and multiple abdominal laparotomies.
Findings:
- The incidence of deep mycoses was observed in this cohort of liver transplant patients.
- Previous broad-spectrum antibiotic use and multiple abdominal laparotomies were strongly associated with deep mycoses.
- Bacterial sepsis and Cytomegalovirus viremia were also noted as significant co-occurring infections.
Implications:
- Early identification and management of risk factors like antibiotic exposure and surgical history are critical.
- Prophylactic strategies against fungal infections may be warranted in high-risk liver transplant patients.
- Multifactorial causes of mortality highlight the complexity of managing post-transplant complications.