title: Spectrum and risk factors for invasive candidiasis and non-Candida fungal infections after liver transplantation.
abstract: BACKGROUND
  Invasive fungal infections are an important cause of posttransplant mortality in solid-organ recipients. The current trend is that the incidence of invasive candidiasis decreases significantly and invasive aspergillosis occurs later in the liver posttransplant recipients. The understanding of epidemiology and its evolving trends in the particular locality is beneficial to prophylactic and empiric treatment for transplant recipients.
  
  
  METHODS
  A retrospective analysis was made of recorded data on the epidemiology, risk factors, and mortality of invasive fungal infections in 352 liver transplant recipients.
  
  
  RESULTS
  Forty-two (11.9%) patients suffered from invasive fungal infection. Candida species infections (53.3%) were the most common, followed by Aspergillus species (40.0%). There were 21 patients with a superficial fungal infection. The median time to onset of first invasive fungal infection was 13 days, first invasive Candida infection 9 days, and first invasive Aspergillus infection 21 days. Fifteen deaths were related to invasive fungal infection, 10 to Aspergillus infection, and 5 to Candida infection. Invasive Candida species infections were associated with encephalopathy (P = 0.009) and postoperative bacterial infection (P = 0.0003) as demonstrated by multivariate analysis. Three independent risk factors of invasive Aspergillus infection were posttransplant laparotomy (P = 0.004), renal dysfunction (P = 0.005) and hemodialysis (P = 0.001).
  
  
  CONCLUSIONS
  The leading etiologic species of invasive fungal infections are Candida and Aspergillus, which frequently occur in the first posttransplant month. Encephalopathy and postoperative bacterial infection predispose to invasive Candida infection. Posttransplant laparotomy and poor perioperative clinical status contribute to invasive Aspergillus infection. More studies are needed to determine the effect of prophylactic antifungal therapy in high risk patients.
authors.affiliation: Department of Hepatobiliary Surgery and Center of Liver Transplantation, First Affiliated Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang 310003, China.
authors.forename: Shao-hua
authors.initials: SH
authors.lastname: Shi
authors.forename: An-wei
authors.initials: AW
authors.lastname: Lu
authors.forename: Yan
authors.initials: Y
authors.lastname: Shen
authors.forename: Chang-ku
authors.initials: CK
authors.lastname: Jia
authors.forename: Wei-lin
authors.initials: WL
authors.lastname: Wang
authors.forename: Hai-yang
authors.initials: HY
authors.lastname: Xie
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Ting-bo
authors.initials: TB
authors.lastname: Liang
authors.forename: Shu-sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D000328:Adult; D001228:Aspergillosis / Q000209:etiology; D002177:Candidiasis / Q000209:etiology*; D003453:Cryptococcosis / Q000209:etiology; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008172:Lung Diseases, Fungal / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors