Background: Invasive fungal infections (IFIs) in liver transplant recipients are associated with increased mortality. Although the risk factors for developing IFIs have been extensively investigated, it is unknown, whether independent predictors of mortality at the time of IFIs diagnosis can be identified.
Methods: A retrospective study was conducted on 171 adult liver transplantation between 1/2008 and 12/2011. Forty-six patients (26%) developed IFIs in the early post-operative course. Survivors (27 patients, 58.7%) and non-survivors (19 patients, 41.3%) characteristics were analyzed. Logistic regression models were used to identify risk factors and to analyze the influence of isolated pathogens and a risk factor sum score (sum of significant risk factors) on patients survival.
Results: Median MELD Score for survivors was 28.8, for non-survivors 35.6 (p<0.02). Candida albicans was cultured in 36 patients (69%), C. non-albicans in 23 patients (50%) and Aspergillus in 6 patients (13%). Some not yet established risk factors showed significant association with mortality: Fluconazole treatment or prophylaxis before detection of IFIs (<0.01), alcohol-induced cirrhosis pre-transplant (<0.02), IFIs intra-abdominally (<0.01), time of IFIs detection post-transplantation (<0.03), presence of multiple drug-resistant organism (<0.02), antibiotic therapy > 14 days (<0.01) and mechanical ventilation > 72 hours (0.01). In a multivariable model, sum score (OR=4.6, p<0.01) and type of pathogen (C. albicans: reference; C. non-albicans and/or Aspergillus: OR=16.4, p=0.06; C. albicans + C.non-albicans and/or Aspergillus: OR=75.8, p=0.02) were significant predictors of mortality with a classification rate of 89% for survivors and 95% for non-survivors.
Additional significant risk factors for in-hospital mortality at the time of IFIs diagnosis were identified. Increasing number of risk factors in association with different type of isolated fungi have strong impact on survival in liver transplant recipient with IFIs.
To cite this abstract in AMA style:Göcze I, Pross A, Zeman F, Farkas S, Scherer M, Lang S, Loss M, Graf B, Bein T, Schlitt H. Invasive Fungal Infection in Liver Transplant Recipients – Focus on Underestimated Risk Factors Associated with In-Hospital Mortality [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/invasive-fungal-infection-in-liver-transplant-recipients-focus-on-underestimated-risk-factors-associated-with-in-hospital-mortality/. Accessed May 8, 2021.
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