Risk Factors of Invasive Fungal Infections in Liver Transplantation: Systematic Review and Meta-Analysis
1University Health Network, Toronto, ON, Canada, 2Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
Meeting: 2020 American Transplant Congress
Abstract number: C-183
Keywords: Fungal infection, Liver transplantation, Meta-analysis
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session C: All Infections (Excluding Kidney & Viral Hepatitis)
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Invasive fungal infection (IFI) remains one of the most common infectious complications after solid organ transplantation. Liver transplant recipients (LTRs) have a higher mortality rates compare to the others. However, risk factors associated with IFI have been noted in small single center studies.
*Methods: We performed a comprehensive search using Ovid MEDLINE, Ovid Embase, Cochrane database of systematic reviews, and Cochrane central register of controlled trials. All case-control and cohort studies evaluating the risk factors for IFI in adult LTRs were screened. Two researchers reviewed, extracted, and assessed all studies independently. We pooled the estimated effect of each independent factor associated with IFI from the multivariate analysis by using the random-effect model. Quality of the studies were assessed using Quality In Prognosis Studies (QUIPS) tool.
*Results: There were 1,862 studies meeting criteria and 28 studies were eligible for meta-analysis. Rates of IFI among all studies ranged from 1.4-36%. Top three Independent risk factors for IFI were vascular complications (OR 8.5; 95%CI 1.8-41.0), renal failure (OR 7.5; 95%CI 1.9-29.0), and fungal colonization (OR 6.9; 95%CI 4-12.1). Other risk factors are shown in table 1 and 2. Previous antibiotic use (OR 9.3; 95%CI 3.2-27.0) and bacterial infection (OR 4.3; 95%CI 2.1-8.6) were independent risk factors of invasive candidiasis. While post-transplant renal replacement therapy (OR 9.2; 95%CI 4.2-20.4), reoperation (OR 8.0; 95%CI 2.9-21.7) and cytomegalovirus infection (OR 6.2; 95%CI 2.0-19.3) were independent risk factors for invasive aspergillosis following LTRs.
*Conclusions: This meta-analysis demonstrates the most important independent predictors of IFI in LTRs. This data can be utilized in targeted antifungal prophylaxis in this population.
| Risk factors | OR | 95%CI |
| Vascular complication | 8.5 | 1.8-41.0 |
| Renal failure | 7.5 | 1.9-29.0 |
| Fungal colonization | 6.9 | 4.0-12.1 |
| Post-transplant renal replacement therapy | 5.5 | 3.2-9.5 |
| Cytomegalovirus infection | 5.0 | 3.2-8.0 |
| Previous antibiotic use | 4.9 | 1.8-13.2 |
| Retransplantation | 4.5 | 2.6-7.8 |
| Risk factors | OR | 95%CI |
| Bacterial infection | 4.3 | 3.0-6.0 |
| Reoperation | 4.0 | 2.8-5.6 |
| Biliary complication | 3.6 | 1.8-7.2 |
| Choledochojejunostomy | 3.3 | 1.9-5.6 |
| Massive blood transfusion | 2.9 | 1.9-4.3 |
| High MELD score | 2.2 | 1.2-4.2 |
| Antifungal prophylaxis | 0.3 | 0.1-0.7 |
To cite this abstract in AMA style:
Phoompoung P, Herrera S, Villalobos APerezCortes, Foroutan F, Orchanian-Cheff A, Husain S. Risk Factors of Invasive Fungal Infections in Liver Transplantation: Systematic Review and Meta-Analysis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-of-invasive-fungal-infections-in-liver-transplantation-systematic-review-and-meta-analysis/. Accessed October 24, 2020.« Back to 2020 American Transplant Congress