Pretransplant model for end stage liver disease score predicts posttransplant incidence of fungal infections after liver transplantation.
Liver transplant recipients are at a significant risk for invasive fungal infections (IFI). This retrospective study evaluated the impact of the pretransplant model for end stage liver disease (MELD) on the incidence of posttransplant IFI in a single centre. From 2004 to 2008, 385 liver transplantations were included, from which 210 transplantations were conducted allocated by Child Turcotte Pugh and 175 were allocated by MELD score. Both groups differed regarding the age of transplant recipients (50.1 ± 10.7 vs. 52.5 ± 9.9, P = 0.036), pretransplant MELD score (16.43 ± 8.33 vs. 18.29 ± 9.05), rate of re-transplantations, duration of surgery, demand in blood transfusions and rates of renal impairments. In the MELD era, higher incidences of IFI (pre-MELD 11.9%, MELD 24.0%, P < 0.05) and Candida infections (9% vs. 18.9%, P < 0.05) were observed. There was no difference in the incidence of probable or possible aspergillosis. Mortality, length of stay in intensive care or hospital, and duration of mechanical ventilation did not differ between the pre-MELD and MELD era. Regardless the date of transplantation, patients with fungi-positive samples showed higher mortality rates than patients without. MELD score was analysed as independent predictors for posttransplant IFI. Higher MELD scores predispose to a more problematic postoperative course and are associated with an increase in fungal infections.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen and Marburg, Rudolf-Buchheim-Straße 7,Giessen, Germany. christoph.lichtenstern@chiru.med.uni-giessen.de
Christoph
C
Lichtenstern
Marcel
M
Hochreiter
Verena D
VD
Zehnter
Thorsten
T
Brenner
Stefan
S
Hofer
Markus
M
Mieth
Markus W
MW
Büchler
Eike
E
Martin
Markus A
MA
Weigand
Peter
P
Schemmer
Cornelius J
CJ
Busch
D018806:APACHE; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D001230:Aspergillus / Q000302:isolation & purification; D002175:Candida / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000401:mortality*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000935:Antifungal Agents