Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

• Published in: Liver transplantation Vol. 21; no. 2; pp. 204 - 212
• Main Authors: Barchiesi, Francesco, Mazzocato, Susanna, Mazzanti, Sara, Gesuita, Rosaria, Skrami, Edlira, Fiorentini, Alessandro, Singh, Nina
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc 01.02.2015
• Subjects: Adult; Amphotericin B - therapeutic use; Aspergillosis - therapy; Aspergillus flavus; Aspergillus fumigatus; Cohort Studies; Female; Humans; Kaplan-Meier Estimate; Liver Failure - complications; Liver Failure - surgery; Liver Transplantation; Male; Middle Aged; Probability; Proportional Hazards Models; Renal Insufficiency - complications; Transplant Recipients; Treatment Outcome; Voriconazole - therapeutic use
• ISSN: 1527-6465; 1527-6473; 1527-6473
• DOI: 10.1002/lt.24032

Invasive aspergillosis (IA) in liver transplant recipients is associated with grave outcomes. We reviewed 116 individual cases reported in the literature from 1985 to 2013. IA was diagnosed after a median of 25 days after transplantation and involved a single organ in 51% of the cases, whereas in the remaining cases, multiple sites were involved. The most common infecting Aspergillus species were Aspergillus fumigatus (73%), Aspergillus flavus (14%), and Aspergillus terreus (8%). Amphotericin B was the drug most frequently used, and it was followed by voriconazole and itraconazole. Combination regimens were used in 51% of the cases. The overall 1‐year cumulative survival probability was 35% [95% confidence interval (CI) = 24.6%‐49.6%]. Survival was significantly higher for patients reported from the year 2000 and thereafter (P < 0.001), for those diagnosed with IA more than 30 days after transplantation versus those diagnosed earlier (P = 0.019), and for patients without renal failure (P = 0.020). Additionally, the use of voriconazole was significantly associated with a higher probability of survival (P < 0.001). Cox regression analysis showed that subjects with the involvement of multiple sites had a 2.52 times higher risk of a negative outcome (95% CI = 1.08‐5.87) than those with the involvement of a single site. Thus, IA causes life‐threatening infections in liver transplant recipients. Predictors associated with poor outcomes may help clinicians to optimize the management of this infection. Liver Transpl 21:204‐212, 2015. © 2014 AASLD.