Aspergillosis in children after liver transplantation: Single center experience.
Aspergillus infection in immunocompromised patients is associated with high morbidity and mortality. We retrospectively reviewed cases of Aspergillosis (A), in a series of 277 children who received LTx between 1990 and 2006. All children were given antifungal prophylaxis after transplantation. Aspergillosis was identified in 10 cases (3.6%) and diagnosis was confirmed when clinical symptoms were associated with identification of Aspergillus sp. or detection of galactomannan antigen. Incidence of Aspergillosis considerably decreased from 6.9% to 0.6% when liposomal amphotericin B was introduced as prophylaxis in high-risk patients. Mean time since LTx to Aspergillosis was 14.5 days. Histologically, Aspergillosis was diagnosed in two cases. Galactomannan antigen was present in two recipients. Aspergillus infection occurs usually within first 30 days after transplantation as a result of a combination of several risk factors. Following risk factors were observed: multiple antibiotic therapy, prolonged intensive care unit stay, poor graft function, retransplantation, relaparotomies, co-infection. Amphotericin B was administered in all cases. Two patients (20%) died because of Aspergillosis Liposomal Amphotericin B prophylaxis in high-risk children decreases the incidence of Aspergillus infection. High index of suspicion and early diagnosis followed by intensive treatment with amphotericin B facilitates achieving mortality rate lower than presented in other reports.
Teisseyre
Joanna
J
Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Warsaw, Poland. jteisseyre@wp.pl
Kaliciński
Piotr
P
Markiewicz-Kijewska
Małgorzata
M
Szymczak
Marek
M
Ismail
Hor
H
Drewniak
Tomasz
T
Nachulewicz
Paweł
P
Broniszczak
Dorota
D
Teisseyre
Mikołaj
M
Pawłowska
Joanna
J
Garczewska
Barbara
B
D000293:Adolescent; D000328:Adult; D000946:Antigens, Fungal / Q000032:analysis; D001228:Aspergillosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007223:Infant; D008099:Liver / Q000382:microbiology* / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011044:Poland / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
D000946:Antigens, Fungal; D007166:Immunosuppressive Agents