title: Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era.
abstract: Antifungal prophylaxis is recommended in high-risk patients, but risk criteria remain unclear and the predictive value of Model of End-Stage Liver Disease (MELD) score is unknown. In a retrospective, single-center analysis of 667 liver transplants, potential risk factors for fungal infection were assessed, including MELD score. Antifungal prophylaxis was administered in 198 patients (29.4%). During follow-up (mean 43.6 ± 29.6 months), 263 patients (39.4%) developed ≥ 1 episode of fungal infection, and 187 (28.0%) patients developed a probable or proven invasive fungal infection requiring systemic antifungal treatment. Patients receiving antifungal prophylaxis had a lower incidence of fungal infection (29.8% vs. 43.5% without prophylaxis, p < 0.001) and invasive fungal infection (17.7% vs. 32.4%, p < 0.001). One-yr patient survival was 91%, 85% and 69%, respectively, in patients with no fungal infection, fungal colonization and treated invasive fungal infection (p < 0.001); graft survival was 88%, 85% and 66% (p < 0.001). Multivariate analysis indicated that MELD score of 20-30 or ≥ 30 was associated with a 2.0-fold or 4.3-fold increase in relative risk of fungal infection, respectively, and a 2.1-fold or 3.1-fold increase in relative risk of invasive fungal infection. In conclusion, liver transplant patients with a MELD score ≥ 20, and particularly patients with a score ≥ 30, are candidates for antifungal prophylaxis.
authors: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France. faouzi.saliba@pbr.aphp.fr
authors: Faouzi
authors: F
authors: Saliba
authors: Valérie
authors: V
authors: Delvart
authors: Philippe
authors: P
authors: Ichaï
authors: Najiby
authors: N
authors: Kassis
authors: Françoise
authors: F
authors: Botterel
authors: Liliana
authors: L
authors: Mihaila
authors: Daniel
authors: D
authors: Azoulay
authors: René
authors: R
authors: Adam
authors: Denis
authors: D
authors: Castaing
authors: Stéphane
authors: S
authors: Bretagne
authors: Didier
authors: D
authors: Samuel
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents
keywords: Aspergillus; Candida; Model of End-Stage Liver Disease; fungal infection; prophylaxis