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, Ryuich
AU - Nobuoka, Daisuke
AU - Kuise, Takashi
AU - Fuji, Tomokazu
AU - Takagi, Kosei
AU - Takaki, Akinobu
AU - Fujiwara, Toshiyoshi
N1 - Publisher Copyright:
© 2018 S. Karger AG, Basel.
PY - 2018/12/1
Y1 - 2018/12/1
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
M3 - Article
C2 - 29649828
AN - SCOPUS:85045324541
VL - 36
SP - 59
EP - 66
JO - Digestive Surgery
JF - Digestive Surgery
SN - 0253-4886
IS - 1
ER -