Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis?

• Published in: Digestive surgery Vol. 36; no. 1; p. 59
• Main Authors: Utsumi, Masashi, Umeda, Yuzo, Yagi, Takahito, Nagasaka, Takeshi, Shinoura, Susumu, Yoshida, Ryuich, Nobuoka, Daisuke, Kuise, Takashi, Fuji, Tomokazu, Takagi, Kosei, Takaki, Akinobu, Fujiwara, Toshiyoshi
• Format: Journal Article
• Language: English
• Published: Switzerland 01.01.2019
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - physiopathology; Adolescent; Adult; Aged; Antibiotic Prophylaxis; Antifungal Agents - therapeutic use; beta-Glucans - blood; End Stage Liver Disease - physiopathology; End Stage Liver Disease - surgery; Female; Humans; Invasive Fungal Infections - diagnosis; Invasive Fungal Infections - microbiology; Invasive Fungal Infections - prevention & control; Liver Transplantation - adverse effects; Living Donors; Male; Middle Aged; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Rate; Young Adult; Acute renal injury; Fungal infection; Living donor liver transplantation
• ISSN: 1421-9883
• DOI: 10.1159/000486548

Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome. Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI. Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.