Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation

Robin Patel, Daniel Portela, Andrew David Badley, William S. Harmsen, Jeffrey J. Larson-Keller, Duane M. Ilstrup, Michael R. Keating, Russell H. Wiesner, Ruud A F Krom, Carlos V. Paya

Research output: Contribution to journalArticle

165 Citations (Scopus)

Abstract

Fungal infections are associated with a high mortality rate after liver transplantation. To describe risk factors for fungal infections, 405 consecutive liver transplant recipients were analyzed. Forty-five patients (11%) developed invasive fungal infection. Median posttransplantation time to the first episode was 60 days. Pathogens were Candida species (spp) (n=24, 53%), Cryptococcus neoformans (n=10, 22%), Aspergillus spp (n=6, 13%), Rhizopus spp (n=1), and others (n=4). Presentations of infection included disseminated (n=9), intra-abdominal (n=9), esophageal (n=9), lung (n=8), blood (n=6), and central nervous system infections (n=3), and sinusitis with esophagitis (n=1). Eighteen patients (40%) with invasive fungal infection died, and 13 (72%) of these deaths were attributable to fungi. Mortality in the nonfungal infection group was 12%. Univariate analysis identified separate risk factors for Candida (intra-abdominal bleeding), Aspergillus (fulminant hepatitis), and cryptococcal (symptomatic cytomegalovirus infection) infections. In both univariate and multivariate analyses, a high intratransplant transfusion requirement and posttransplant bacterial infection were identified as significant risk factors for all types of fungal infection. The risk factor analysis reported here suggests that different pathogenic processes lead to Candida and non-Candida infection in liver transplant recipients. Their identification should prompt specific prophylactic measures to reduce morbidity and mortality in this population.

Original languageEnglish (US)
Pages (from-to)926-934
Number of pages9
JournalTransplantation
Volume62
Issue number7
DOIs
StatePublished - Oct 15 1996

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Mycoses
Candida
Liver Transplantation
Aspergillus
Infection
Mortality
Rhizopus
Central Nervous System Infections
Cryptococcus neoformans
Esophagitis
Liver
Sinusitis
Cytomegalovirus Infections
Bacterial Infections
Hepatitis
Statistical Factor Analysis
Fungi
Multivariate Analysis
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation. / Patel, Robin; Portela, Daniel; Badley, Andrew David; Harmsen, William S.; Larson-Keller, Jeffrey J.; Ilstrup, Duane M.; Keating, Michael R.; Wiesner, Russell H.; Krom, Ruud A F; Paya, Carlos V.

In: Transplantation, Vol. 62, No. 7, 15.10.1996, p. 926-934.

Research output: Contribution to journalArticle

Patel, R, Portela, D, Badley, AD, Harmsen, WS, Larson-Keller, JJ, Ilstrup, DM, Keating, MR, Wiesner, RH, Krom, RAF & Paya, CV 1996, 'Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation', Transplantation, vol. 62, no. 7, pp. 926-934. https://doi.org/10.1097/00007890-199610150-00010
Patel, Robin ; Portela, Daniel ; Badley, Andrew David ; Harmsen, William S. ; Larson-Keller, Jeffrey J. ; Ilstrup, Duane M. ; Keating, Michael R. ; Wiesner, Russell H. ; Krom, Ruud A F ; Paya, Carlos V. / Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation. In: Transplantation. 1996 ; Vol. 62, No. 7. pp. 926-934.
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AU - Badley, Andrew David

AU - Harmsen, William S.

AU - Larson-Keller, Jeffrey J.

AU - Ilstrup, Duane M.

AU - Keating, Michael R.

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