Aspergillosis in liver transplant recipients: successful treatment and improved survival using a multistep approach.
BACKGROUND
Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.


METHODS
We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center.


RESULTS
A diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary involvement; 1 presented with an inguinal mass. Time from transplant to infection ranged from 1 week to 34 months. Treatment included surgical intervention and medical treatment. All patients infected with Aspergillus fumigatus were treated with a sequential protocol of lipid complex amphotericin followed by itraconazole. The major side effect of treatment was worsening renal function. One patient died of intracranial hemorrhage during treatment.


CONCLUSIONS
Successful treatment of aspergillosis in liver transplant recipients should include early diagnosis, sequential medical treatment with lipid amphotericin B and itraconazole, and surgical intervention for invasive disease.
Duchini
Andrea
A
Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, Calif 92037, USA.
Redfield
David C
DC
McHutchison
John G
JG
Brunson
Mathew E
ME
Pockros
Paul J
PJ
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007264:Inguinal Canal / Q000601:surgery; D017964:Itraconazole / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008168:Lung / Q000187:drug effects / Q000601:surgery; D008172:Lung Diseases, Fungal / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008206:Lymphatic Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010713:Phosphatidylcholines / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000627:therapeutic use*; D012189:Retrospective Studies; D015996:Survival Rate
D000935:Antifungal Agents; D004338:Drug Combinations; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B