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


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
Publication statusAccepted/In press - Apr 12 2018



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

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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