Risk Factors for Fungal Infections After Liver Transplantation: A Matched Cohort Analysis

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Abstract

Introduction

Fungal infections after transplantation are associated with high morbidity and mortality. Awareness of the treating physicians and thereby early detection is key to successful treatment. Aim of the present study was to identify risk factors for fungal infections in a cohort of liver transplant recipients in the MELD era.

Patients and Methods

Out of 579 adult patients transplanted from 01/2012-12/2016, 33 (5.6%) patients developed fungal infections after liver transplantation. These 33 patients (mean age 48 years; LabMELD 22) were matched with 99 patients (mean age 50 years; LabMELD 22) without fungal infections after transplantation by MELD score and age. Standard donor and recipient and procedural factors were analyzed and correlated with occurrence of fungal infections and outcomes by univariable/multivariable statistics. Fungal prophylaxis is not administered at our center.

Results

After adjustment by multivariable analysis the Donor Risk Index (p=0.02) and dialysis after transplantation (p=0.01) were independently associated with occurrence of fungal infections. 30-day and 12-month survival in patients with fungal infections were 63.6% and 48.5%, respectively, while patients without fungal infections demonstrated 30-day and 12 month survival rates of 85.9% and 76.7%, respectively (p<0.01).

Conclusions

Rates of fungal infections are low after liver transplantation in the modern MELD era. Indeed, outcome is significantly diminished if fungal infections occur. Patients requiring hemodialysis after liver transplantation are under high risk of this dangerous complication and should therefore be monitored carefully.

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