title: Fungal complications after Candida preservation fluid contamination in liver transplant recipients.
abstract: Donor-derived fungal infections can be associated with severe complications in transplant recipients. Donor-derived candidiasis has been described in kidney transplant recipients where contamination of the preservation fluid (PF) was a commonly proposed source. In liver transplantation, these fungal infections have been less explored. The aim of this study was therefore to determine the incidence and clinical relevance of Candida contamination of preservation fluid in the context of liver transplantation. A 5-year (2008-2012) retrospective multicentre study involving six French liver transplantation centers was performed to determine the incidence of Candida PF contamination. Postoperative clinical features, outcomes in recipients, and risk factors for Candida-related complications of liver transplantation were studied. Candida sp. was isolated from 28 of 2107 preservation fluid samples (1.33%). Candida albicans was the most common yeast (n = 18, 64%). Twenty-two recipients (78.5%) received antifungal therapy (echinocandins in 68%) for 7-37 days. Eight patients developed yeast-related complications (28.6%) including hepatic artery aneurysms (n = 6) and Candida peritonitis (n = 2). The 1-year mortality rate among patients after a yeast-related complication was 62.5%. The incidence of Candida PF contamination was low, but was associated with dramatic postoperative complications and high mortality. Close radiological follow-up may enable early recognition of the arterial complications associated with PF contamination by Candida.
authors.affiliation: Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.affiliation: Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.|Sorbonne Paris Cité, Univ Paris Diderot, Paris, France.|INSERM U773, CRB3, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.affiliation: Hepato-Biliairy Centre - Liver ICU, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.affiliation: Intensive Care & Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Khoy-Ear
authors.affiliation: Anesthesiology Department & Intensive Care - Liver ICU, AP-HP GH Henri Mondor, Créteil, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Merle
authors.affiliation: Department of Critical Care Medicine and Anesthesiology, Saint Eloi Teaching Hospital, Montpellier, France.|INSERM U-1046, University Montpellier I, Montpellier II, Montpellier, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Jung
authors.affiliation: Intensive Care & Anesthesiology Department, CHU Bordeaux, Bordeaux, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Stecken
authors.affiliation: Intensive Care & Anesthesiology Department, SAMU, CHU Tours, Tours, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Ferrandiere
authors.affiliation: Microbiology Unit, G.H. Kremlin-Bicètre, Kremlin-Bicètre, France.
authors.forename: Liliana
authors.initials: L
authors.lastname: Mihaila
authors.affiliation: Mycology Unit - Microbiology Department, DHU VIC, EA Dynamyc UPEC-ENVA-GH Henri Mondor, Créteil, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Botterel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida; D002177:Candidiasis / Q000150:complications*; D004866:Equipment Contamination; D005260:Female; D005602:France; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019188:Organ Preservation Solutions / Q000009:adverse effects*; D010538:Peritonitis / Q000382:microbiology; D011184:Postoperative Period; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D019188:Organ Preservation Solutions
keywords: Candida; aneurysm; fungal infection; liver transplantation; preservation fluid