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Retrospective study evaluating the performance of risk factors for invasive mold infections in liver transplantation
Karyna M Neyra1, Kyle D Brizendine1
1Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
Background:
Mold infections in liver transplant are associated with high mortality. Guidelines recommend prophylaxis targeted against mold based upon risk factors of fulminant hepatic failure, retransplantation, reoperation, and renal replacement therapy post-transplant. It is not known if these factors identify risk of mold infection at every center.
Methods:
A retrospective study was conducted of adult liver transplant recipients at a single center from 2010 to 2014. The association between risk factors and invasive mold infection and effect of antifungal prophylaxis were determined.
Results:
Five hundred thirty-four liver transplant recipients were identified. The overall incidence of invasive mold infection was 0.9% (N = 5). The incidence in patients with (N = 128) and without (N = 406) risk factors was 0.78% and 0.98%, respectively. Antifungal prophylaxis with mold activity was administered to 23/128 (18%) with risk factors, and none developed infection. No mold-active prophylaxis was given to 105/128 (82%) with risk factors, and incidence of mold infection was 0.95% (N = 1). Number needed to treat was 105.
Conclusions:
Traditional risk factors for mold infection in liver transplant performed poorly. These results underscore the importance of transplant center-specific data to inform adoption of an antifungal prophylactic strategy. Studies are needed to determine alternative risk factors to facilitate appropriate targeting of antifungals.
Insights
Invasive mold infections after liver transplant are serious. Traditional risk factors did not accurately predict mold infection risk in this study, suggesting a need for center-specific strategies.
Area of Science:
- Transplant Infectious Diseases
- Mycology
- Immunocompromised Host Infections
Background:
- Invasive mold infections post-liver transplant carry high mortality.
- Current guidelines recommend antifungal prophylaxis based on specific risk factors.
- The efficacy of these risk factors in identifying infection risk across different transplant centers is unclear.
Purpose of the Study:
- To evaluate the association between traditional risk factors and invasive mold infection in liver transplant recipients.
- To assess the impact of antifungal prophylaxis on mold infection rates.
- To determine the predictive value of established risk factors at a single transplant center.
Main Methods:
- Retrospective analysis of adult liver transplant recipients from 2010-2014.
- Identification of patients with and without traditional risk factors for mold infection.
- Comparison of mold infection incidence and antifungal prophylaxis use between groups.
Main Results:
- The overall incidence of invasive mold infection was 0.9% (5/534).
- Patients with risk factors had a similar incidence (0.78%) compared to those without (0.98%).
- Antifungal prophylaxis in 18% of high-risk patients prevented infections; 82% without prophylaxis had a 0.95% infection rate.
Conclusions:
- Traditional risk factors for mold infection in liver transplant recipients demonstrated poor predictive performance.
- Transplant center-specific data are crucial for developing effective antifungal prophylactic strategies.
- Further research is needed to identify alternative risk factors for targeted antifungal use.
