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Risk factors for invasive fungal infections complicating orthotopic liver transplantation
L A Collins1, M H Samore, M S Roberts
1Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215.
Abstract:
Risk factors for invasive fungal infection in patients undergoing orthotopic liver transplantation were examined. Thirty-four of 168 transplants were complicated within 100 days after transplantation by documented invasive fungal infection (Candida species, 28 patients; mycelial fungi, 5; both Candida and Aspergillus species, 1). In the multivariate Cox proportional hazards model, three baseline and two posttransplant variables were independently significant risk factors for infection: level of creatinine (hazard ratio = 1.4), length of transplant operation (HR = 1.2), retransplantation (HR = 3.2), abdominal or intrathoracic reoperations (HR = 2.5), and cytomegalovirus infection (HR = 8.5). Four predictors (creatinine of > 3.0 mg/dL, operative time of > or = 11 h, retransplantation, and early colonization) assessable at the time of transplantation or shortly thereafter were incorporated into a simple predictive model for risk stratification. The risk of invasive fungal infection ranged from 1% in patients with no predictors to 67% in patients with two or more predictors. Strategies to prevent invasive fungal infections after liver transplantation should be targeted to these high-risk groups.
Insights
Identifying invasive fungal infection risk factors in liver transplant recipients is crucial. Key predictors include creatinine levels, operation length, retransplantation, reoperations, and cytomegalovirus infection, enabling targeted prevention strategies.
Area of Science:
- Medical Science
- Transplantation Immunology
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) pose a significant threat to liver transplant recipients.
- Early identification of risk factors is essential for effective prophylaxis and management.
Purpose of the Study:
- To identify and validate independent risk factors for invasive fungal infection following orthotopic liver transplantation.
- To develop a predictive model for stratifying patients based on their risk of developing IFIs.
Main Methods:
- A multivariate Cox proportional hazards model was employed to analyze data from 168 liver transplant recipients.
- Baseline and post-transplant variables were assessed for their association with IFIs within 100 days.
- A predictive model was constructed using significant risk factors identifiable early in the transplant course.
Main Results:
- Significant risk factors identified include elevated creatinine, prolonged operative time, retransplantation, abdominal/intrathoracic reoperations, and cytomegalovirus infection.
- A predictive model incorporating creatinine levels, operative time, retransplantation, and early colonization demonstrated risk stratification capabilities.
- Patients with no predictors had a 1% risk, while those with two or more predictors faced a 67% risk of IFIs.
Conclusions:
- Specific clinical and laboratory parameters serve as independent predictors of invasive fungal infection post-liver transplantation.
- A simple predictive model can effectively stratify patients into high- and low-risk categories for IFIs.
- Targeted preventive strategies should be implemented for high-risk liver transplant recipients to reduce the incidence of IFIs.