title: Performance Characteristics of Galactomannan and β-d-Glucan in High-Risk Liver Transplant Recipients.
abstract: BACKGROUND
  The utility of Aspergillus galactomannan (GM) and β-D-glucan (BG) in liver transplant recipients remains uncertain.
  
  
  METHODS
  As part of a randomized, double-blind trial of antifungal prophylaxis in liver transplant recipients at risk for invasive fungal infections (IFIs), GM and BG were assessed in 199 patients at baseline (enrollment) and weekly thereafter for the duration of study drug. Receiver operating characteristic (ROC) analysis was used to evaluate the accuracy of these for the diagnosis of IFIs.
  
  
  RESULTS
  Overall, 46.4% of the patients at baseline had positive GM (index ≥ 0.5) and 89.6% had BG of 80 pg/mL or greater with BG level of 500 pg/mL or greater in 31.8%. Patients with invasive aspergillosis (IA) (3/3) had positive GM at baseline as did 45.5% of those without IA (P = 0.098); the area under the ROC curve for the diagnosis of IA was 0.77 (fair test, ie, good sensitivity but poor specificity). Using BG cutoff of 80 pg/mL or higher, 100% (12/12) of the patients with IFI had positive baseline BG and as did 88.9% (160/180) of those without IFI (P = 0.618); the area under the ROC curve for predicting IFIs was 0.56 (poor test). In multivariate analyses, GM positivity was associated with study site (P = 0.041), and BG positivity with renal replacement therapy (P = 0.05) and study site (P = 0.01). The GM and BG levels declined over time; positivity at subsequent time points was lower in comparison with baseline (P < 0.001).
  
  
  CONCLUSIONS
  The GM and BG tests had significant center variability and limited accuracy for the diagnosis of IFIs in high-risk liver transplant recipients.
authors.affiliation: 1 Division of Infectious Diseases, VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA. 2 Department of Surgery, University of California Los Angeles Medical Center, Los Angeles, CA. 3 Division of Infectious Diseases, University of Washington, Seattle, WA. 4 Division of Infectious Diseases, University of Michigan, Ann Arbor, MI. 5 Division of Infectious Diseases, University of Wisconsin, Madison, WI. 6 Division of Infectious Diseases, University of Miami, Miami, FL. 7 Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA. 8 Mira Vista Diagnostics, Indianapolis, IN.
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Drew J
authors.initials: DJ
authors.lastname: Winston
authors.forename: Ajit P
authors.initials: AP
authors.lastname: Limaye
authors.forename: Shawn
authors.initials: S
authors.lastname: Pelletier
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.forename: Michele I
authors.initials: MI
authors.lastname: Morris
authors.forename: Katherine
authors.initials: K
authors.lastname: Meneses
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Wheat
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008351:Mannans / Q000378:metabolism*; D008875:Middle Aged; D011183:Postoperative Complications / Q000378:metabolism* / Q000517:prevention & control; D011446:Prospective Studies; D011509:Proteoglycans; D012372:ROC Curve; D012307:Risk Factors; D055815:Young Adult; D047071:beta-Glucans / Q000378:metabolism*
chemical_list: D000935:Antifungal Agents; D008351:Mannans; D011509:Proteoglycans; D047071:beta-Glucans; C012990:galactomannan; C010770:polysaccharide-K; D005690:Galactose