Risk factors for invasive fungal infections complicating orthotopic liver transplantation.
Risk factors for invasive fungal infection in patients undergoing orthotopic liver transplantation were examined. Thirty-four of 168 transplants were complicated within 100 days after transplantation by documented invasive fungal infection (Candida species, 28 patients; mycelial fungi, 5; both Candida and Aspergillus species, 1). In the multivariate Cox proportional hazards model, three baseline and two posttransplant variables were independently significant risk factors for infection: level of creatinine (hazard ratio = 1.4), length of transplant operation (HR = 1.2), retransplantation (HR = 3.2), abdominal or intrathoracic reoperations (HR = 2.5), and cytomegalovirus infection (HR = 8.5). Four predictors (creatinine of > 3.0 mg/dL, operative time of > or = 11 h, retransplantation, and early colonization) assessable at the time of transplantation or shortly thereafter were incorporated into a simple predictive model for risk stratification. The risk of invasive fungal infection ranged from 1% in patients with no predictors to 67% in patients with two or more predictors. Strategies to prevent invasive fungal infections after liver transplantation should be targeted to these high-risk groups.
Collins
L A
LA
Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215.
Samore
M H
MH
Roberts
M S
MS
Luzzati
R
R
Jenkins
R L
RL
Lewis
W D
WD
Karchmer
A W
AW
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001228:Aspergillosis / Q000453:epidemiology*; D001806:Blood Urea Nitrogen; D002177:Candidiasis / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016853:Muromonab-CD3 / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012086:Reoperation; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D016853:Muromonab-CD3; D003404:Creatinine