title: Invasive fungal infections following liver transplantation - risk factors, incidence and outcome.
abstract: BACKGROUND
  The incidence of invasive fungal infections (IFIs), particularly candidiasis and aspergillosis, following solid organ transplantation vary from 1.4% to 42%. IFIs most commonly occur after orthotropic liver transplantation (OLT), lung/heart and pancreas transplantation. Mortality related to IFIs depends on the type of transplant and vary from 3% to 100% of cases. The results largely depend on early initiation of specific treatment for IFIs. Therefore, the diagnosis has to be prompt and based on known risk factors - time of surgical procedure, type of biliary anastomosis, blood loss, rate of rejection and re-transplantation.
  
  
  METHODS
  We evaluated the incidence of fungal infections in patients after liver transplantation in our center. The retrospective analysis of 175 consecutive OLT patients was undertaken to estimate incidence, risk factors and clinical courses of IFIs in the last 6 years at our center.
  
  
  RESULTS
  Infections involving Aspergillus (6 cases), Candida (24 cases) and Cryptococcus (1 case) were observed in 17.7% of our recipients. Except for 1 case (Cryptococcus encephalitis), all of the episodes developed during the first month post-transplantation. All cases of lung aspergillosis developed in patients with autoimmune cholestasis prior to transplantation. In 1 case after transplantation, in a patient with bile duct necrosis requiring reoperation, pneumonia developed. In 3 cases, pulses of steroids were used to treat acute rejection. Apart from that, none of the potential risk factors of IFIs described by other authors were noted. Five out of 6 cases of aspergillosis survived on combined antifungal therapy. The recipient diagnosed with cryptococcal encephalitis died. All cases with urinary tract (n=18; 8.6%) or respiratory (n=6; 3.4%) candidiasis survived.
  
  
  CONCLUSIONS
  Early diagnosis and prompt treatment is fundamental for patient survival.
authors.affiliation: Department of General Surgery and Transplantology, Medical University of Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Pacholczyk
authors.forename: Beata
authors.initials: B
authors.lastname: Lagiewska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Lisik
authors.forename: Dariusz
authors.initials: D
authors.lastname: Wasiak
authors.forename: Andrzej
authors.initials: A
authors.lastname: Chmura
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000209:etiology; D058365:Candidiasis, Invasive / Q000209:etiology; D003453:Cryptococcosis / Q000209:etiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents