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Fungal infections in liver transplant recipients
Abstract:
A retrospective analysis of 462 consecutive orthotopic liver transplantations was undertaken to evaluate incidence, risk factors, clinical course, and outcome of fungal infections. Infections involving Aspergillus (6 cases), Candida (5 cases), Mucor (1 case), and Cryptococcus (1 case) were observed in 2.8% (13/462) of our patients. Twelve of the 13 episodes developed during the first 2 postoperative months. None of the potential risk factors for fungal infections described by other authors (i.e., age, rejection treatment, dialysis, mechanical ventilation, graft failure, long operation time, second transplant, serious non-fungal infection) correlated significantly with the episodes in our patients. However, in patients who exhibited three or more of these potential risk factors the incidence of fungal infections was elevated (P < 0.001). Six of seven exogenous infections (Aspergillus, Mucor) began before July 1991 when our department moved from Charlottenburg to Wedding, thus indicating that the incidence of these infections is highly influenced by exposure (P = 0.01). Exposure prophylaxis should therefore by meticulously followed, particularly when severely compromised patients are involved, in order to prevent exogenous infections (i.e., Aspergillus/Mucor). Infections involving such patients are combined with a very high mortality (57%). We observed Candida infection as a pathological overgrowth of physiological oropharynx flora into the esophagus and/or trachea in five patients. In each case treatment led to full recovery.
Insights
Fungal infections occurred in 2.8% of liver transplant patients, primarily within two months post-surgery. Environmental exposure significantly influenced exogenous fungal infections, highlighting the need for strict prophylaxis in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Transplant Surgery
- Infectious Diseases
Background:
- Fungal infections pose a significant threat to immunocompromised patients, particularly liver transplant recipients.
- Understanding the incidence, risk factors, and outcomes of these infections is crucial for improving patient management.
Purpose of the Study:
- To evaluate the incidence, risk factors, clinical course, and outcomes of fungal infections in orthotopic liver transplant recipients.
- To identify specific fungal pathogens and assess their association with patient characteristics and treatment strategies.
Main Methods:
- A retrospective analysis of 462 consecutive orthotopic liver transplantations.
- Identification and categorization of fungal infections, including Aspergillus, Candida, Mucor, and Cryptococcus.
- Statistical analysis to determine correlations between potential risk factors and fungal infection incidence.
Main Results:
- Fungal infections were identified in 2.8% of patients (13/462), with most occurring within two months post-transplant.
- No single risk factor correlated significantly, but the presence of three or more risk factors elevated infection incidence (P < 0.001).
- Exogenous infections (Aspergillus, Mucor) were linked to environmental exposure (P = 0.01), with a high mortality rate (57%) in affected patients. Candida infections resolved with treatment.
Conclusions:
- Environmental exposure is a critical factor for exogenous fungal infections in liver transplant patients, necessitating stringent prophylaxis.
- While individual risk factors were not significant, a combination of factors increases susceptibility.
- Candida infections are manageable, but exogenous fungal infections carry a high mortality risk, emphasizing prevention in high-risk individuals.