title: Epidemiology of invasive fungal infections after liver transplantation and the risk factors of late-onset invasive aspergillosis.
abstract: Invasive fungal infection (IFI) in liver transplant recipients is associated with poor outcomes. Targeted antifungal prophylaxis is recommended for high-risk populations; however, the epidemiology of IFI has changed, and the risk criteria remain unclear. In addition, the risk factors for late-onset invasive aspergillosis (IA) have not been fully characterized. We examined 279 recipients over 16 years of age to uncover their IFI epidemiology, clinical characteristics and outcomes. In addition, a case-control study was performed to identify the risk factors of late-onset IA. Of the 279 recipients, 96.1% underwent living donor liver transplantation. Antifungal prophylaxis was administered to 80.6% of the recipients. IFI occurred in 15 patients, among which 8 cases were early-onset (≤90 days after liver transplantation) and 7 cases were late-onset (>90 days after liver transplantation). Five of the late-onset cases were invasive pulmonary aspergillosis, and 2 were fungemia cases. The mortality rate of late-onset IA was 80.0%. According to a multivariate analysis, steroid use before liver transplantation, bloodstream infection within 90 days after liver transplantation and reoperation within 90 days after liver transplantation were significant risk factors for late-onset IA after liver transplantation. The prevalence of IFI was low in our population given that over 80% of liver recipients received antifungal prophylaxis. The prognosis of late-onset IA remains poor, and predictors associated with late-onset IA, such as steroid use before liver transplantation, bloodstream infection and reoperation after liver transplantation, may help clinicians to optimize prevention measures for these devastating infections.
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan. Electronic address: mnagao@kuhp.kyoto-u.ac.jp.
authors.forename: Miki
authors.initials: M
authors.lastname: Nagao
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Matsumura
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Kaido
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takakura
authors.affiliation: Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
authors.affiliation: Department of Infection Control and Prevention, Kyoto University Hospital, Japan; Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichiyama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Antifungal prophylaxis; Invasive aspergillosis; Liver transplantation; Risk factor