title: Trends in invasive fungal infections in liver transplant recipients: correlation with evolution in transplantation practices.
abstract: BACKGROUND
  The incidence of invasive fungal infections, particularly invasive candidiasis, after liver transplantation is strongly influenced by surgical factors and technical complexity of the surgery. We assessed the temporal trends in invasive fungal infections in the context of evolution in liver transplantation practices, technical developments, and other risk factors.
  
  
  METHODS
  Demographic and clinical characteristics of the patients, transplantation-related variables, and rates of infection were longitudinally analyzed over the last 10 years in 190 consecutive liver transplant recipients at our institution. Trends for categorical data were evaluated using the Cochran-Armitage trend test and for continuous variables using analysis of variance with linear contrast.
  
  
  RESULTS
  A decrease in the length of operation (P=0.03), intraoperative transfusion requirements (P=0.0001), cold ischemic time (P<0.0001), use of roux-en-Y biliary anastomosis (P=0.0015), rate of biopsy proven rejection (P<0.0001), and retransplantation (P=0.056) was documented over the successive years. A significant decline in Child-Pugh score (P=0.02) and in the proportion of patients transplanted as UNOS 2a occurred (P=0.0001). Although the incidence of cytomegalovirus infection remained unchanged, a significant increase in the frequency of primary cytomegalovirus infection (P=0.045), and a decrease in cytomegalovirus disease (P=0.0006) was documented. Over the same time period, a significant decrease in the incidence of invasive candidiasis (P=0.015), and an insignificant increase in the rate of invasive aspergillosis (P=0.20) occurred.
  
  
  CONCLUSIONS
  Notable technical developments in liver transplantation practices and risk profiles of patients have occurred over the decade. These variables may have a role in influencing the evolving trends in invasive fungal infections in liver transplant recipients.
authors.affiliation: VA Medical Center, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Ignazio R
authors.initials: IR
authors.lastname: Marino
authors.forename: Timothy
authors.initials: T
authors.lastname: Gayowski
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001228:Aspergillosis / Q000453:epidemiology; D001803:Blood Transfusion; D002177:Candidiasis / Q000453:epidemiology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005260:Female; D005704:Gallbladder / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods* / Q000473:pathology / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies