title: The risk factors of fungal infection in living-donor liver transplantations.
abstract: OBJECTIVE
  The aim of the study was to retrospectively assess in a Japanese university hospital the risk factors for fungal infections and mortality in living-donor liver transplantations (LDLTs). Although fungal infections are an important complication associated with high mortality in liver transplantation, the risk factors for fungal infections developing after LDLT remain poorly understood.
  
  
  METHODS
  Patient records for a total of 156 patients undergoing LDLT over a 6-year period in our institution were retrospectively evaluated. All transplant recipients were routinely observed for fungal infections with close monitoring for febrile episodes and collection and culture of saliva, pharynx, sputum, urine, feces, and drain discharge specimens undertaken. Fungal infection was defined as proposed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group. Patients with definite or probable infection were diagnosed as having specific invasive fungal infection in this study. Data were reviewed and collated from these patients' records, and multivariate analyses were performed to identify possible risk factors for mortality and the development of fungal infections.
  
  
  RESULTS
  Nineteen of 156 patients (12.2%) developed invasive fungal infections, involving Candida spp. (n = 13), Pneumocystis jiroveci (n = 4), and Aspergillus spp. (n = 2). Eight of these 19 patients died, 4 from pneumonia, and 1 each from cerebral hemorrhage, chronic rejection, virus-associated hemophagocytic syndrome, and cancer recurrence. The 5-year survival rate was significantly lower in patients with fungal infections than in those without (53 vs. 90%; p < 0.001). Fungal infection was independently associated with reoperation (odds ratio 6.92, 1.82-26.27, p = 0.004), posttransplant dialysis (5.62, 1.51-20.88, p = 0.009), and bacterial infection (3.94, 1.02-15.26, p = 0.04).
  
  
  CONCLUSIONS
  Independent risk factors of fungal infection after LDLT are reoperation, posttransplant dialysis, and bacterial infection.
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000293:Adolescent; D000328:Adult; D001228:Aspergillosis / Q000453:epidemiology; D001656:Biliary Atresia / Q000601:surgery; D002177:Candidiasis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015209:Cholangitis, Sclerosing / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D016720:Pneumocystis Infections / Q000453:epidemiology; D045363:Pneumocystis carinii; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult