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Cited by 22Antifungal resistance and susceptibilityFungal Infections and StudiesOrgan Transplantation Techniques and Outcomes

Epidemiology and risk factors for invasive fungal disease in liver transplant recipients in a tertiary transplant center

Lum, Lionel, Lee, Andie, Vu, Monica, Strasser, Simone, Davis, Rebecca·2020·Transplant Infectious Disease
DOI 10.1111/tid.13361
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Abstract

Background: Invasive fungal disease (IFD) in liver transplant recipients causes significant morbidity and mortality. We aim to describe institutional epidemiology and risk factors for IFD in the liver transplant population. Methods: We conducted a retrospective cohort study of all adult liver transplant recipients in our institution from 2005 to October 2015 to describe the epidemiology of patients with proven and probable IFD according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. To determine risk factors for IFD, a case‐control study was also conducted. Cases were defined as liver transplant recipients with proven or probable IFD, and controls were defined as liver transplant recipients without IFD. Each case was matched to two controls by age (±10 years of age), gender, and time of transplant (within one year of the case). Results: 28/554 (5.1%) patients developed IFD. Candidiasis (n = 11; 39.3%), Aspergillosis (n = 10; 35.7%), and Cryptococcosis (n = 3; 10.7%) were the most common fungal infections in the proven and probable IFD groups. Mold infections occurred in 13 (46.4%) cases. Reoperation, roux‐en‐y anastomosis, and massive intraoperative transfusion of ≥40 units of cellular blood products were major risk factors for IFD in the multivariate analysis. Conclusion: Candida and Aspergillus are the most common causes of IFD in liver transplantation in our center. There is significant overlap in risk factors for such infections post‐transplantation. In our cohort, critically ill patients with complicated perioperative course seem to predispose them to mold infections post‐transplantation, but larger studies are required to better delineate risk factors for mold infection as well as determine the efficacy and optimal duration of mold prophylaxis in liver transplantation. With increasing echinocandin use for antifungal prophylaxis, it is also important to monitor for emerging antifungal resistance.

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  • Invasive fungal infections and the immunocompromised population have increased, carrying significant mortality and healthcare costs.

    “The incidence of invasive fungal infections (IFI) has since increased along with the immunocompromised population carrying significant mortality rates and costs to healthcare systems [3, 4].”

    From Investigational Agents for the Treatment of Resistant Yeasts and Molds (2021) · cites this paper as [4]

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Authors
Lum, L., Lee, A., Vu, M., Strasser, S., & Davis, R.
Affiliations
  • Royal Prince Alfred Hospital (AU)
  • The University of Sydney (AU)
  • UNSW Sydney (AU)
Corresponding author
Lum, Lionel
ORCID
Venue
Transplant Infectious Disease
Publisher
Wiley
Published
2020-06-22
Volume
22
Issue
6
Pages
e13361-e13361
ISSN
  • 1398-2273 (ISSN-L)
  • 1399-3062
DOI
10.1111/tid.13361
OpenAlex
W3033355033
Cited by
22
References
34
Citations by year
2026: 2 · 2025: 4 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 5
FWCI
0.49
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Transplant Infectious Disease (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Keywords
invasive fungal infections, liver transplantation, candidiasis, aspergillosis, cryptococcosis, mold infections, risk factors, reoperation, Roux-en-Y anastomosis, antifungal prophylaxis, echinocandin resistance
MeSH terms
Invasive Fungal Infections, Adult, Anastomosis, Roux-en-Y, Antifungal Agents, Aspergillosis, Cryptococcosis, Female, Humans, Male, Middle Aged, Reoperation, Retrospective Studies, Risk Factors, Case-Control Studies, Liver Transplantation, Drug Resistance, Fungal, Echinocandins, Candidiasis, Invasive, Tertiary Care Centers

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