Risk factors associated with invasive fungal disease post-liver transplantation

Invasive Fungal Infections (IFI) are significant causes of morbidity and mortality after liver transplantation. Infections occurring within the first 90-days post-transplant are considered early, with Candida species, Aspergillus, and Cryptococcus being the primary agents of early IFI. Various factors have been identified in studies of risk factors for IFI after liver transplantation, with differing results between studies and transplant centers. The main objective of this study was to identify risk factors associated with invasive fungal disease and mortality within the first 100-days post-liver transplantation in two Brazilian centers.

A retrospective multicenter case-control study was conducted in two Brazilian liver transplant centers.

66 cases of IFI and 198 controls were analysed. Intrabdominal site infection was the most prevalent, in 34 cases (46%) and non-albicans Candida species were the main etiologies, and the most used prophylactic antifungal was fluconazole. In multivariate analysis, antifungal prophylaxis (OR = 0.397, 95% CI 0.167‒0.941) and deceased donor (OR = 0.312, 95% CI 0.109‒0.893) were protective factors, while renal replacement therapy (OR = 4.104, 95% CI 1.744‒9.965) and reoperation (OR = 5.368, 95% CI 2.739‒10.521) were independent risk factors for developing IFI. Survival was lower in patients with an invasive fungal disease, vascular complications, and renal dysfunction within the first 100-days post-transplant.

The use of antifungal prophylaxis and transplantation with a deceased donor were protective factors for IFI, whereas reoperation and renal replacement therapy were risk factors, and the occurrence of and IFI diminishes post-transplant survival.