Introduction: Invasive aspergillosis is a rare but severe complication following liver transplantation (LTX) with reported mortality rates up to 100%. Our purpose was to investigate aspergillosis treatment and outcome under the new antifungal medication.

Methods: We retrospectively analysed all LTX performed at our university hospital between 2009 and 2013 with special regard to cases of posttransplant invasive aspergillosis defined as aspergillus detection (based on antigen testing or microbiological/histological proof) in combination with clinical symptoms. Cases were studied for patient characteristics, clinical course and therapy.

Results: 16/408 (=3.9%) patients developed invasive aspergillosis, 14 patients with singular (lung n=12, brain n=1, abdomen n=1) and 2 patients with multiple organ (brain/lung n=1, brain/eye n=1) affection. These 14 patients (median age 62(range 2-69) years; 12 male, 4 female; MELD 31(10-40)) were transplanted for alcoholic liver disease (n=5), hepatitis C (n=3), acute liver failure (n=3), cryptogenic cirrhosis (n=2), primary sclerosing cholangitis (n=1), autoimmune hepatitis (n=1) and primary hyperoxaluria (n=1). Six patients underwent re-LTX due to early (primary non function n=3, biliary complications n=1) or late liver graft failure (chronic rejection n=2) prior to aspergillosis. First positive aspergillus testing was median 3 (range 0-132) days after LTX, detecting Aspergillus fumigatus species in all cases. Concomitant infections include candida 11/16(69%), CMV 5/16(31%), bacterial 16/16(100%) and HSV 4/16(25%) infection.

Antifungal therapy consisted of echinocandins (88%, median therapy duration 11(range 1-65)days), azoles (69%, 17(2-265)days) and amphotericin B (13%, 1+8days), thereof monotherapy in 6 patients (echinocandin n=4, azole n=1, amphotericin B n=1), dual therapy in 9 patients (echinocandin+azole) and triple therapy in 1 patient (echinocandin+azole+amphotericin B).

Aspergillus dependant mortality was 44% (7/16), long-term follow-up revealed 31% (5/16) alive with well-functioning liver graft 1.5, 3.1, 4.1, 4.3 and 4.9 years after invasive aspergillosis (singular lung affection in all patients).

Conclusion: Current antifungal therapy, consisting of echinocandins mainly in combination with new azoles, achieved in our patients with invasive aspergillosis following LTX, in general a highly fatal situation, an impressive cure rate of 56%.

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