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Non-Aspergillus invasive mould infections in liver transplant recipients: A French national retrospective
Cléa Melenotte1,2, Coralie Le Hyaric3, Céline Guichon4
1Université Paris Cité, Hôpital Universitaire Necker-Enfants malades, Service de Maladies Infectieuses et Tropicales, Assistance Publique des Hôpitaux de Paris, 75743 PARIS CEDEX 15, France.
Background:
Non-Aspergillus invasive mould infections (IMIs) are emerging in immunocompromised patients, and liver is the second most commonly organ transplanted worldwide.
Methods:
We conducted a multicenter retrospective case-control (1:1) study of liver transplant (LT) recipients diagnosed with non-Aspergillus IMIs in France between January 2007 and December 2021.
Results:
We identified 27/14 332 (0.18%) LT recipients with non-Aspergillus IMIs. Mucorales spp. (48%) were the most common pathogens, followed by Scedosporium spp. (14%), Fusarium spp. (14%), and other IMIs (25%). Lungs were the primary infection site, followed by soft tissues, abdomen, brain, sinuses, heart, and bone. Multivariate analysis showed that a Model for End-stage Liver Disease score > 20 prior to transplantation and primary antifungal prophylaxis (with echinocandins or fluconazole) tended to increase the risk of non-Aspergillus IMIs by nearly threefold ((adjusted Odd Ratio (aOR): 3.73, 95% Confidence Interval (CI) [0.90-15.45], P = .07) and (aOR: 3.93; 95% CI [0.94-16.42], P = .06), respectively). The 6-month mortality rate was 55%. In a Cox survival model, non-Aspergillus IMIs were associated with a threefold increase in mortality risk (Hazard Ratio (HR) : 3.82 [2.01-7.26] P < .001).
Conclusion:
Non-Aspergillus IMIs are rare but highly fatal infections whose early diagnosis in high-risk liver-transplanted patients is essential. Whether or not recently available molecular tools for diagnosing non-Aspergillus IMIs will improve their prognosis in the liver transplantation setting remains to be studied.
Insights
Non-Aspergillus invasive mould infections are rare but deadly in liver transplant recipients. Early diagnosis is crucial for improving outcomes in these high-risk patients.
Area of Science:
- Medical Mycology
- Transplant Infectious Diseases
- Immunocompromised Host Infections
Background:
- Non-Aspergillus invasive mould infections (IMIs) are an increasing concern in immunocompromised individuals.
- Liver transplantation is a common procedure worldwide, making liver transplant recipients a vulnerable population.
Purpose of the Study:
- To investigate the incidence, risk factors, and outcomes of non-Aspergillus IMIs in liver transplant (LT) recipients.
- To highlight the critical need for early diagnosis and management of these infections.
Main Methods:
- A multicenter retrospective case-control study was conducted.
- Liver transplant recipients diagnosed with non-Aspergillus IMIs between 2007 and 2021 were analyzed.
- Statistical analyses included multivariate analysis and Cox survival models.
Main Results:
- Non-Aspergillus IMIs occurred in 0.18% of LT recipients, with Mucorales spp. being the most frequent pathogen.
- High Model for End-stage Liver Disease (MELD) score and primary antifungal prophylaxis were associated with increased risk.
- The 6-month mortality rate was 55%, with non-Aspergillus IMIs tripling the mortality risk.
Conclusions:
- Non-Aspergillus IMIs are rare, highly fatal complications in liver transplant recipients.
- Early diagnosis and prompt management are essential for improving patient prognosis.
- The impact of novel molecular diagnostic tools on outcomes requires further investigation.
