[Invasive mycoses in liver transplantation].
Seventy three adults underwent orthotopic liver transplantations between February 1987 and November 1989 and were followed (54 retrospectively and 19 in a prospective study) with the aim of establishing the incidence of deep mycoses (3 disseminated candidiasis due to C. albicans, 1 invasive aspergillosis due to A. fumigatus and 1 invasive pulmonary aspergillosis due to A. niger and A. fumigatus). 4/5 of these infections occurred in the first month after transplantation. All the patients were associated with the following clinical risk factors: previous use of wide spectrum antibiotics (5/5); more than 1 abdominal laparotomy (4/5), due to primary failure of the graft (3/4) and thrombosis of the hepatic artery (1/4). Two of the three patients [corrected] with invasive candidiasis had previous episodes of documented fungemia. 24 patients of the group who didn't show MIP had some risk factor which in all of them was the previous use of high dose steroids and/or of wide spectrum antibiotics, in addition to the used in surgical prophylaxis. In our series, the one risk factor associated with MIP was more than one previous laparotomy (p less than 0.001). Other significant associated infections were 3 bacterial sepsis (2 due to Enterococcus faecalis and 1 due to Staphylococcus epidermidis) and one viral (Cytomegalovirus viremia). The mortality rate was 100%, however the cause of death was multifactorial.
Servicio de Microbiología, Hospital 12 de Octubre, Madrid.
J
J
Romanyk
A
A
del Palacio
C
C
Fiaño
C
C
Lumbreras
S
S
Cuétara
P
P
Moreno
J L
JL
Sánchez-Rivas
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008172:Lung Diseases, Fungal / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents
Micosis invasivas en el trasplante hepático.