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Published on: March 22, 2012
Determining the incidence of aspergillosis after liver transplant
Parisa Badiee1, Abdolvahab Alborzi, Seyed Ali Malekhosseini
1Prof. Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Badieep@yahoo.com
Objectives:
Aspergillus has become an increasingly frequent cause of life-threatening opportunistic infections in liver transplant recipients. This study seeks to determine the incidence of invasive aspergillosis in liver transplant recipients using routine and molecular methods in a teaching hospital in Shiraz, the unique center for liver transplant in Iran.
Materials And Methods:
Four hundred eight recipients who underwent liver transplant were followed for Aspergillus infections by microscopic examination, culture, and nested polymerase chain reaction. Blood samples were cultured by bedside inoculation to BACTEC medium.
Results:
The female-to-male ratio was 151:257 (mean age, 29.6 years; mean hospitalization, 26 days). Sensitivity and specificity of the nested polymerase chain reaction was 92.8% and 94%. Aspergillosis was detected in 19 recipients (4.6%) by routine and molecular method (4 proven, 10 probable, and 5 possible) of whom 12 recipients died (63.2%).
Conclusions:
This study found the incidence rate of invasive aspergillosis as an uncommon complication of liver transplant recipient cases but associated with poor outcomes. The rate is consistent with those reported in previous studies, but molecular assay that is more-sensitive and specific was used in the present study.
Insights
Invasive aspergillosis is an uncommon but serious complication after liver transplantation. This study highlights its incidence and poor outcomes in Iranian liver transplant recipients, emphasizing the utility of molecular methods.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Clinical Microbiology
Background:
- Aspergillosis is a growing threat in immunocompromised patients, particularly liver transplant recipients.
- Early and accurate diagnosis is crucial for managing invasive fungal infections in this vulnerable population.
Purpose of the Study:
- To determine the incidence of invasive aspergillosis in liver transplant recipients.
- To evaluate routine and molecular diagnostic methods for Aspergillus infections.
- To assess outcomes associated with invasive aspergillosis in this cohort.
Main Methods:
- Prospective follow-up of 408 liver transplant recipients.
- Infection surveillance using microscopy, culture, and nested polymerase chain reaction (PCR).
- Blood cultures performed using BACTEC medium.
Main Results:
- Invasive aspergillosis was detected in 4.6% of recipients (19 cases).
- Nested PCR demonstrated high sensitivity (92.8%) and specificity (94%).
- A high mortality rate of 63.2% was observed among infected patients.
Conclusions:
- Invasive aspergillosis is an uncommon but severe complication post-liver transplant with significant mortality.
- The study confirms findings from previous research while showcasing the improved diagnostic capabilities of molecular assays.
- Accurate diagnosis using sensitive methods like nested PCR is vital for improving patient outcomes.
