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Fungus infections after liver transplantation
Abstract:
The problem of fungus infections after liver transplantation was studied. In 100 consecutive recipients of orthotopic liver homografts there were 10 and 8 examples, respectively, of localized and disseminated infections caused by Candida species. Candidemia was demonstrated in 8 of these 18 patients. One patient who had a localized Candida infection also had disseminated cryptococcosis. An additional 31 patients were infested in that Candida could be cultured from sites where it is not normally found, such as the blood (8 examples), urine (8), ascitic fluid (8), and wounds (22). This exorbitant incidence of monilial infections and infestations was associated with a high frequency of complications involving the homograft as well as the hosts' gastrointestinal tract during the post-transplantation period. The yeasts found in blood, urine, ascitic fluid and elsewhere were thought to have originated from the gut. Ten of the 100 patients had aspergillosis which was localized in 7 instances and disseminated in 3. The lung was the most frequently affected organ. The fungus infections played a contributory role in the downhill course of our patients but in the event of death more fundamental and more frequent causes of failure were technical complications involving the homografts, difficulties in controlling rejection with reasonable immunosuppressive doses and bacterial sepsis. Suggestions have been made for the better control of fungal infections in liver recipients.
Insights
Fungal infections, particularly Candida, are common after liver transplants, affecting 18% of patients. While contributing to complications, technical issues and bacterial sepsis were more frequent causes of mortality.
Area of Science:
- Medical Mycology
- Transplantation Immunology
- Gastroenterology
Background:
- Liver transplantation recipients face significant risks of opportunistic infections.
- Fungal infections, especially Candida species, pose a threat in immunocompromised patients.
Purpose of the Study:
- To investigate the incidence and impact of fungal infections in orthotopic liver homograft recipients.
- To identify common fungal pathogens and affected sites post-liver transplantation.
Main Methods:
- Prospective study of 100 consecutive liver transplant recipients.
- Clinical monitoring for localized and disseminated fungal infections.
- Microbiological cultures from various body sites, including blood, urine, ascitic fluid, and wounds.
Main Results:
- Candida infections occurred in 18% of patients (10 localized, 8 disseminated), with candidemia in 8.
- Aspergillosis affected 10% of patients (7 localized, 3 disseminated), primarily in the lungs.
- Fungal infestations were linked to homograft and gastrointestinal complications.
Conclusions:
- Fungal infections are a significant concern in liver transplant recipients.
- While contributing to morbidity, technical complications, rejection, and bacterial sepsis were more critical in mortality.
- Strategies for improved fungal infection control in liver transplant patients are needed.