Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation

Which Patient Needs Potent Prophylaxis?

Masashi Utsumi, Yuzo Umeda, Takahito Yagi, Takeshi Nagasaka, Susumu Shinoura, Ryuichi Yoshida, Daisuke Nobuoka, Takashi Kuise, Tomokazu Fuji, Kosei Takagi, Akinobu Takaki, Toshiyoshi Fujiwara

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. Results: 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. Conclusion: 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.

Original languageEnglish
JournalDigestive Surgery
DOIs
Publication statusAccepted/In press - Apr 12 2018

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Living Donors
Liver Transplantation
Transplants
Liver
Trichosporon
End Stage Liver Disease
Invasive Fungal Infections
Aspergillus
Candida
Acute Kidney Injury
Early Diagnosis
Multivariate Analysis
Survival Rate
Kidney
Mortality
Therapeutics

Keywords

  • Acute renal injury
  • Fungal infection
  • Living donor liver transplantation

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{b2f4e73215bc4be6b38e357014a55ee0,
title = "Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis?",
abstract = "Background: 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. Methods: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. Results: 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. Conclusion: 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.",
keywords = "Acute renal injury, Fungal infection, Living donor liver transplantation",
author = "Masashi Utsumi and Yuzo Umeda and Takahito Yagi and Takeshi Nagasaka and Susumu Shinoura and Ryuichi Yoshida and Daisuke Nobuoka and Takashi Kuise and Tomokazu Fuji and Kosei Takagi and Akinobu Takaki and Toshiyoshi Fujiwara",
year = "2018",
month = "4",
day = "12",
doi = "10.1159/000486548",
language = "English",
journal = "Digestive Surgery",
issn = "0253-4886",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation

T2 - Which Patient Needs Potent Prophylaxis?

AU - Utsumi, Masashi

AU - Umeda, Yuzo

AU - Yagi, Takahito

AU - Nagasaka, Takeshi

AU - Shinoura, Susumu

AU - Yoshida, Ryuichi

AU - Nobuoka, Daisuke

AU - Kuise, Takashi

AU - Fuji, Tomokazu

AU - Takagi, Kosei

AU - Takaki, Akinobu

AU - Fujiwara, Toshiyoshi

PY - 2018/4/12

Y1 - 2018/4/12

N2 - Background: 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. Methods: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012. Results: 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. Conclusion: 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.

KW - Acute renal injury

KW - Fungal infection

KW - Living donor liver transplantation

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U2 - 10.1159/000486548

DO - 10.1159/000486548

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JO - Digestive Surgery

JF - Digestive Surgery

SN - 0253-4886

ER -