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Fungal infections in liver transplant recipients
Abstract:
Sixty-two adults who underwent orthotopic liver transplantations between February 1981 and June 1983 were followed for a mean of 170 days after the operation. Twenty-six patients developed 30 episodes of significant fungal infection. Candida species and Torulopsis glabrata were responsible for 22 episodes and Aspergillus species for 6. Most fungal infections occurred in the first month after transplantation. In the first 8 weeks after transplantation, death occurred in 69% (18/26) of patients with fungal infection but in only 8% (3/36) of patients without fungal infection (P less than 0.0005). The cause of death, however, was usually multifactorial, and not solely due to the fungal infection. Fungal infections were associated with the following clinical factors: administration of preoperative steroids (P less than 0.05) and antibiotics (P less than 0.05), longer transplant operative time (P less than 0.02), longer posttransplant operative time (P less than 0.01), duration of antibiotic use after transplant surgery (P less than 0.001), and the number of steroid boluses administered to control rejection in the first 2 posttransplant months (P less than 0.01). Patients with primary biliary cirrhosis had fewer fungal infections than patients with other underlying liver diseases (P less than 0.05). A total of 41% (9/22) of Candida infections resolved, but all Aspergillus infections ended in death.
Insights
Fungal infections, particularly Candida and Aspergillus, significantly increased mortality in liver transplant recipients. Prophylactic measures and early detection are crucial for improving outcomes in these high-risk patients.
Area of Science:
- Medical Mycology
- Transplant Surgery
- Immunocompromised Host Infections
Background:
- Liver transplantation is a complex procedure with significant risks.
- Fungal infections pose a serious threat to transplant recipients, impacting survival rates.
Purpose of the Study:
- To investigate the incidence, types, and outcomes of fungal infections following orthotopic liver transplantation.
- To identify clinical factors associated with fungal infections and their impact on patient mortality.
Main Methods:
- Retrospective analysis of 62 adult liver transplant recipients from February 1981 to June 1983.
- Monitoring for fungal infections, primarily Candida, Torulopsis glabrata, and Aspergillus species.
- Correlation of fungal infections with clinical factors and patient outcomes, including mortality.
Main Results:
- Twenty-six patients experienced 30 fungal infections, predominantly Candida and Aspergillus species, within the first post-transplant month.
- Fungal infections were strongly associated with increased mortality (69% vs. 8%, P < 0.0005).
- Risk factors included preoperative steroids/antibiotics, longer operative times, and post-transplant steroid use for rejection.
Conclusions:
- Fungal infections are a major cause of morbidity and mortality in liver transplant recipients.
- Early recognition and management of fungal infections, alongside judicious use of immunosuppressants and antibiotics, are critical.
- Specific fungal species, like Aspergillus, had a near-certain fatal outcome in this cohort.