[Invasive fungal infections in liver transplant recipients: analysis of 21 cases].
BACKGROUND
Invasive fungal infections (IFI) are one of the most important causes of mortality in liver transplant (LT) recipients. The aim of this study was to describe the characteristics of IFI in the LT program of our institution with an special emphasis in the differences between Candida infections (CI) and that caused by other fungi (NCI).


METHODS
Retrospective analysis of the hospital charts of 21 patients who underwent a LT from February 1987 to December 1995. The diagnosis of IFI required the histological evidence of tissue invasion or a positive culture in a tissue sample or in an usually sterile fluid. Esophageal candidiasis was not considered as IFI. Antifungal prophylaxis was performed either with nystatin or fluconazole.


RESULTS
Twenty-one of 356 patients (6%) developed a total of 23 episodes of IFI. Pathogens were Candida spp. (n = 10), Aspergillus (n = 8), Zygomicetes (n = 4) and Cryptococcus (n = 1). Fifty-seven percent of the episodes of IFI (80% of those caused by Candida and 38% of those produced by other fungi; p < 0.05) developed in the first 3 months after transplantation and only 5 episodes appeared after the sixth month. The diagnosis of IFI was done at autopsy in 6 patients (29%). Overall, NCI (13 episodes) predominated over CI (10 episodes), being the later the cause of the 54% of the episodes in the first 178 recipients but only the 30% in the last 178 patients (p = 0.09). No differences were found in the distribution of the risk factors amongst those patients with CI or NCI. Seventeen of the 21 patients (71%) died and 15 of these deaths (72%) were attributable to fungi; 15 patients who died either did not receive amphotericin (n = 6) or received a cumulative dose lower than 500 mg. Six patients received a cumulative dose of more than 1.5 g (mean, 3.2 g) and four of them were cured. Mortality in the nonfungal infection group was 26% (p < 0.001).


CONCLUSIONS
IFI was a rare but severe complication in our LT recipients. The relative frequency of CI was progressively decreasing during the study period, being NCI the predominant infections. Amphotericin therapy was effective only when a high cumulative dose could be administered.
Miguélez
M
M
Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid.
Lumbreras
C
C
Herrero
J A
JA
Aguado
J M
JM
del Palacio
A
A
Colina
F
F
Gómez
R
R
Lizasoain
M
M
Moreno
E
E
Rodríguez-Noriega
A
A
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D009761:Nystatin / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000935:Antifungal Agents; D009761:Nystatin; D000666:Amphotericin B; D015725:Fluconazole
Infección fúngica profunda en receptores de un trasplante de hígado: análisis de 21 casos.