title: Invasive aspergillosis in liver transplant recipients: epidemiology, clinical characteristics, treatment, and outcomes in 116 cases.
abstract: Invasive aspergillosis (IA) in liver transplant recipients is associated with grave outcomes. We reviewed 116 individual cases reported in the literature from 1985 to 2013. IA was diagnosed after a median of 25 days after transplantation and involved a single organ in 51% of the cases, whereas in the remaining cases, multiple sites were involved. The most common infecting Aspergillus species were Aspergillus fumigatus (73%), Aspergillus flavus (14%), and Aspergillus terreus (8%). Amphotericin B was the drug most frequently used, and it was followed by voriconazole and itraconazole. Combination regimens were used in 51% of the cases. The overall 1-year cumulative survival probability was 35% [95% confidence interval (CI) = 24.6%-49.6%]. Survival was significantly higher for patients reported from the year 2000 and thereafter (P < 0.001), for those diagnosed with IA more than 30 days after transplantation versus those diagnosed earlier (P = 0.019), and for patients without renal failure (P = 0.020). Additionally, the use of voriconazole was significantly associated with a higher probability of survival (P < 0.001). Cox regression analysis showed that subjects with the involvement of multiple sites had a 2.52 times higher risk of a negative outcome (95% CI = 1.08-5.87) than those with the involvement of a single site. Thus, IA causes life-threatening infections in liver transplant recipients. Predictors associated with poor outcomes may help clinicians to optimize the management of this infection.
authors.affiliation: Infectious Diseases Clinic, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barchiesi
authors.forename: Susanna
authors.initials: S
authors.lastname: Mazzocato
authors.forename: Sara
authors.initials: S
authors.lastname: Mazzanti
authors.forename: Rosaria
authors.initials: R
authors.lastname: Gesuita
authors.forename: Edlira
authors.initials: E
authors.lastname: Skrami
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fiorentini
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000628:therapy*; D001231:Aspergillus flavus; D001232:Aspergillus fumigatus; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications; D066027:Transplant Recipients; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000666:Amphotericin B; D065819:Voriconazole