title: Risk factors of invasive Candida and non-Candida fungal infections after liver transplantation.
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=l), 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.
authors.affiliation: Division of Infectious Diseases and Internal Medicine, Department of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: D
authors.initials: D
authors.lastname: Portela
authors.forename: A D
authors.initials: AD
authors.lastname: Badley
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: J J
authors.initials: JJ
authors.lastname: Larson-Keller
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
authors.forename: M R
authors.initials: MR
authors.lastname: Keating
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
mesh_terms: D000704:Analysis of Variance; D002177:Candidiasis / Q000209:etiology*; D005069:Evaluation Studies as Topic; D006801:Humans; D016031:Liver Transplantation; D009181:Mycoses / Q000209:etiology*; D011183:Postoperative Complications; D012307:Risk Factors