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Risk factors for systemic fungal infections in liver transplant recipients
1Institut für Anaesthesíologie, Abteilung Medizinische Mikrobiologie, Ludwig-Maximilians-Universität München, Germany.
Abstract:
The risk factors for systemic fungal infections were analysed retrospectively in 186 orthotopic liver transplant procedures performed in 152 patients between June 1985 and January 1993. The total incidence of systemic fungal infections was 16.5% (25/152). The incidence of disseminated candidiasis, aspergillosis, and combined candidiasis and aspergillosis was 6.5% (n = 10), 7.2% (n = 11) and 2.6% (n = 4), respectively. Mortality associated with systemic fungal infections was 80% (20 of 25 patients). There were ten cases of disseminated candidiasis, with 4 patients surviving, and 11 cases of invasive aspergillosis, with 1 patient surviving. All patients with combined systemic fungal infection died. To identify perioperative risk factors, 39 variables were used to compare patients with systemic fungal infections versus those without fungal infections. Fourteen variables were significantly associated with systemic fungal infections by univariate analysis. A consecutive logistic regression analysis revealed that the amount of fresh frozen plasma transfused due to poor initial function of the allograft and acute renal failure requiring hemofiltration were independently significant risk factors for systemic fungal infections. There was no statistical correlation between systemic fungal infections and the underlying liver disease, previous long-term corticosteroids and the postoperative immunosuppressive therapy. Risk factors identified in this study should be considered in the postoperative care of the individual liver transplant recipient. In our study a poor initial function of the hepatic allograft substantially increased the risk of systemic fungal infection.
Insights
Systemic fungal infections occurred in 16.5% of liver transplant patients, with high mortality. Poor initial allograft function and acute renal failure requiring hemofiltration were key risk factors.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Critical Care Medicine
Background:
- Systemic fungal infections pose a significant threat to liver transplant recipients.
- Understanding perioperative risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To retrospectively analyze risk factors for systemic fungal infections after orthotopic liver transplantation.
- To identify independent predictors of fungal infections in this patient population.
Main Methods:
- Retrospective analysis of 186 liver transplant procedures in 152 patients.
- Comparison of 39 variables between patients with and without fungal infections.
- Univariate and logistic regression analyses to identify significant risk factors.
Main Results:
- Overall incidence of systemic fungal infections was 16.5%, with 80% mortality.
- Disseminated candidiasis (6.5%) and aspergillosis (7.2%) were most common.
- Independent risk factors included fresh frozen plasma transfusion for poor allograft function and acute renal failure requiring hemofiltration.
Conclusions:
- Poor initial liver allograft function and acute renal failure requiring hemofiltration are significant risk factors for systemic fungal infections post-transplant.
- These findings highlight the need for vigilant monitoring and management of these complications.
- No correlation was found with underlying liver disease, prior corticosteroid use, or immunosuppressive therapy regimens.