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 language | English |
|---|---|
| Journal | Digestive Surgery |
| DOIs | |
| Publication status | Accepted/In press - Apr 12 2018 |
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Keywords
- Acute renal injury
- Fungal infection
- Living donor liver transplantation
ASJC Scopus subject areas
- Surgery
- Gastroenterology
Cite this
Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation : Which Patient Needs Potent Prophylaxis? / Utsumi, Masashi; Umeda, Yuzo; Yagi, Takahito; Nagasaka, Takeshi; Shinoura, Susumu; Yoshida, Ryuichi; Nobuoka, Daisuke; Kuise, Takashi; Fuji, Tomokazu; Takagi, Kosei; Takaki, Akinobu; Fujiwara, Toshiyoshi.
In: Digestive Surgery, 12.04.2018.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85045324541&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045324541&partnerID=8YFLogxK
U2 - 10.1159/000486548
DO - 10.1159/000486548
M3 - Article
JO - Digestive Surgery
JF - Digestive Surgery
SN - 0253-4886
ER -