A risk profile for invasive aspergillosis in liver transplant recipients.
BACKGROUND
Given the high incidence (1.5%-10%) of invasive aspergillosis (IA) after liver transplantation and the associated mortality, prophylaxis according to the patients' circumstances is a reasonable approach. The purpose of this investigation was to determine the effect and significance of risk factors for IA in a specialized transplantation center.


METHODS
We collected data from patients who underwent liver transplantation at the Transplantation Center of the University Hospital Heidelberg (Germany) between December 2001 and December 2004 in a specifically designed database for retrospective analysis. Invasive aspergillosis was defined according to the European Organization for Research and Treatment of Cancer classifications. Univariate analysis and logistic regression were performed to assess the influence of each assumed risk factor.


RESULTS
A total of 195 liver transplantations were performed in 170 patients, with two patients (1.2%) developing a proven IA, seven (4.1%) developing a probable IA, and five developing a possible IA (2.9%). All patients received oral itraconazole prophylaxis. Of these 14 patients with proven, probable or possible IA, 13 died within 4 weeks after the initial diagnosis; this represents 33.3% of all patients with a fatal outcome. Univariate significant factors were retransplantation (p = 0.004), cytomegalovirus (CMV) infection (p = 0.024), dialysis (p < 0.001), renal insufficiency (p = 0.05), thrombocytopenia (p = 0.001), and leukocytopenia (p = 0.002). Multivariate analysis showed an independent influence of CMV infection (OR 6.032, 95% CI 1.446-25.163) and dialysis (OR 14.985, 95%CI 2.936-76.486).


CONCLUSIONS
The rate of IA found in this investigation is within the range reported in published studies. Based on our data, extended antifungal prophylaxis should be given to liver transplant patients with specific risk factors, such as renal insufficiency, requirement for dialysis, CMV infection, or thrombocytopenia. Additional focus should be on the prevention of CMV infections.
Rosenhagen
M
M
Pharmacy Dept., University Hospital of Heidelberg, Heidelberg, Germany. maike.rosenhagen@med.uni-heidelberg.de
Feldhues
R
R
Schmidt
J
J
Hoppe-Tichy
T
T
Geiss
H K
HK
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000453:epidemiology* / Q000401:mortality; D018890:Chemoprevention / Q000379:methods; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D017964:Itraconazole / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014180:Transplantation
D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D017964:Itraconazole