Risk Factors for Fungal Infection in Adult Recipients Following Living Donor Liver Transplantation_West China Medical Journal

Authors：

 QinLi , LuoYuou ,  LuoYanli

Department of Hepatic Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LuoYanli, Email: luoyl@126.com

Keywords：

Living donor liver transplantation; Fungal infection; Risk factors

DOI：

10.7507/1002-0179.201600186

Video：

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Objective To analyze the risk factors associated with fungal infections in adult recipients after living donor liver transplantation (LDLT). Methods Data of 189 recipients from January 2006 to December 2012 who received LDLT at our center were retrospectively analyzed. Cox regression analysis was used to analyze the risk factors for postoperative fungal infections. Results Postoperative fungal infection was found in 12 recipients. The most common infectious site was lung, whereas the most common fungal pathogen was Candida albicans. Multivariate analysis suggested preoperative low albumin level [HR=0.792, 95%CI (0.694, 0.903), P=0.001], massive intraoperative red blood cell transfusion [HR=4.322, 95%CI (1.308, 14.277), P=0.016] and longer postoperative intensive care unit (ICU) stay [HR=3.399, 95%CI (1.004, 11.506), P=0.049] were the independent risk factors for postoperative fungal infections. Conclusions Lung is the most common fungal infection site after LDLT. Preoperative low albumin level, massive intraoperative red blood cell transfusion and longer postoperative ICU contribute to fungal infections after LDLT.

Citation： QinLi, LuoYuou, LuoYanli. Risk Factors for Fungal Infection in Adult Recipients Following Living Donor Liver Transplantation. West China Medical Journal, 2016, 31(4): 679-682. doi: 10.7507/1002-0179.201600186 Copy

1.	Gautam M, Chopra KB, Douglas DD, et al. Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates[J]. Liver Transpl, 2007, 13(11): 1582-1588.
2.	Eschenauer GA, Lam SW, Carver PL. Antifungal prophylaxis in liver transplant recipients[J]. Liver Transpl, 2009, 15(8): 842-858.
3.	Liu X, Ling ZX, Li LJ, et al. Invasive fungal infections in liver transplantation[J]. Int J Infect Dis, 2011, 15(5): E298-E304.
4.	Shepherd RW, Turmelle Y, Nadler M, et al. Risk factors for rejection and infection in pediatric liver transplantation[J]. Am J Transplant, 2008, 8(2): 396-403.
5.	Cockbain AJ, Goldsmith PJ, Gouda M, et al. The impact of postoperative infection on long-term outcomes in liver transplantation[J]. Transplant Proc, 2010, 42(10): 4181-4183.
6.	Mccluskey SA, Karkouti K, Wijeysundera DN, et al. Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation[J]. Liver Transpl, 2006, 12(11): 1584-1593.
7.	Gallardo ML, Gutierrez ME, Perez GS, et al. Risk factors for renal dysfunction in the postoperative course of liver transplant[J]. Liver Transpl, 2004, 10(11): 1379-1385.
8.	Zhong L, Men TY, Li H, et al. Multidrug-resistant gram-negative bacterial infections after liver transplantation-spectrum and risk factors[J]. J Infect, 2012, 64(3): 299-310.
9.	Sganga G, Bianco G, Frongillo F, et al. Fungal infections after liver transplantation: incidence and outcome[J]. Transplant Proc, 2014, 46(7): 2314-2318.
10.	Saliba F, Delvart V, Ichaï P, et al. Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era[J]. Clin Transplant, 2013, 27(4): E454-E461.
11.	Yang CH, He XS, Chen J, et al. Fungal infection in patients after liver transplantation in years 2003 to 2012[J]. Ann Transplant, 2012, 17(4): 59-63.
12.	Raghuram A, Restrepo A, Safadjou SA, et al. Invasive fungal infections following liver transplantation: incidence, risk factors, survival, and impact of fluconazole-resistant candida parapsilosis (2003-2007)[J]. Liver Transpl, 2012, 18(9): 1100-1109.
13.	Nafady-Hego H, Elgendy H, Moghazy WE, et al. Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: an 11-year single-center experience[J]. Liver Transpl, 2011, 17(8): 976-984.
14.	Li C, Wen TF, Mi K, et al. Analysis of infections in the first 3-month after living donor liver transplantation[J]. World J Gastroenterol, 2012, 18(16): 1975-1980.
15.	Mnatzaganian G, Galai N, Sprung CL, et al. Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards[J]. J Hosp Infect, 2005, 59(4): 331-342.
16.	Suljagić V, Cobeljić M, Janković S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients[J]. Am J Infect Control, 2005, 33(6): 333-340.
17.	Otan E, Aydin C, Usta S, et al. Acinetobacter infection in a liver transplantation intensive care unit[J]. Transplant Proc, 2013, 45(3): 998-1000.
18.	Singh N, Gayowski T, Wagener MM, et al. Pulmonary infiltrates in liver transplant recipients in the intensive care unit[J]. Transplantation, 1999, 67(8): 1138-1144.
19.	Avkan-Oguz V, Ozkardesler S, Unek T, et al. Risk factors for early bacterial infections in liver transplantation[J]. Transplant Proc, 2013, 45(3): 993-997.
20.	Li C, Mi K, Wen TF, et al. Risk factors and outcomes of massive red blood cell transfusion following living donor liver transplantation[J]. J Dig Dis, 2012, 13(3): 161-167.
21.	Subramanian V, Bharat A, Vachharajani N, et al. Perioperative blood transfusion affects hepatitis C virus (HCV)-specific immune responses and outcome following liver transplantation in HCV-infected patients[J]. HPB (Oxford), 2014, 16(3): 282-294.
22.	Benson AB, Burton JR, Austin GL, et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation[J]. Liver Transpl, 2011, 17(2): 149-158.
23.	Lee S, Gj S, Kim SY, et al. Intraoperative predictors of early tracheal extubation after living-donor liver transplantation[J]. Korean J Anesthesiol, 2014, 67(2): 103-109.
24.	Ikegami T, Shirabe K, Matono R, et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation[J]. Liver Transpl, 2012, 18(9): 1060-1068.

1. Gautam M, Chopra KB, Douglas DD, et al. Streptococcus salivarius bacteremia and spontaneous bacterial peritonitis in liver transplantation candidates[J]. Liver Transpl, 2007, 13(11): 1582-1588.
2. Eschenauer GA, Lam SW, Carver PL. Antifungal prophylaxis in liver transplant recipients[J]. Liver Transpl, 2009, 15(8): 842-858.
3. Liu X, Ling ZX, Li LJ, et al. Invasive fungal infections in liver transplantation[J]. Int J Infect Dis, 2011, 15(5): E298-E304.
4. Shepherd RW, Turmelle Y, Nadler M, et al. Risk factors for rejection and infection in pediatric liver transplantation[J]. Am J Transplant, 2008, 8(2): 396-403.
5. Cockbain AJ, Goldsmith PJ, Gouda M, et al. The impact of postoperative infection on long-term outcomes in liver transplantation[J]. Transplant Proc, 2010, 42(10): 4181-4183.
6. Mccluskey SA, Karkouti K, Wijeysundera DN, et al. Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation[J]. Liver Transpl, 2006, 12(11): 1584-1593.
7. Gallardo ML, Gutierrez ME, Perez GS, et al. Risk factors for renal dysfunction in the postoperative course of liver transplant[J]. Liver Transpl, 2004, 10(11): 1379-1385.
8. Zhong L, Men TY, Li H, et al. Multidrug-resistant gram-negative bacterial infections after liver transplantation-spectrum and risk factors[J]. J Infect, 2012, 64(3): 299-310.
9. Sganga G, Bianco G, Frongillo F, et al. Fungal infections after liver transplantation: incidence and outcome[J]. Transplant Proc, 2014, 46(7): 2314-2318.
10. Saliba F, Delvart V, Ichaï P, et al. Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era[J]. Clin Transplant, 2013, 27(4): E454-E461.
11. Yang CH, He XS, Chen J, et al. Fungal infection in patients after liver transplantation in years 2003 to 2012[J]. Ann Transplant, 2012, 17(4): 59-63.
12. Raghuram A, Restrepo A, Safadjou SA, et al. Invasive fungal infections following liver transplantation: incidence, risk factors, survival, and impact of fluconazole-resistant candida parapsilosis (2003-2007)[J]. Liver Transpl, 2012, 18(9): 1100-1109.
13. Nafady-Hego H, Elgendy H, Moghazy WE, et al. Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: an 11-year single-center experience[J]. Liver Transpl, 2011, 17(8): 976-984.
14. Li C, Wen TF, Mi K, et al. Analysis of infections in the first 3-month after living donor liver transplantation[J]. World J Gastroenterol, 2012, 18(16): 1975-1980.
15. Mnatzaganian G, Galai N, Sprung CL, et al. Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards[J]. J Hosp Infect, 2005, 59(4): 331-342.
16. Suljagić V, Cobeljić M, Janković S, et al. Nosocomial bloodstream infections in ICU and non-ICU patients[J]. Am J Infect Control, 2005, 33(6): 333-340.
17. Otan E, Aydin C, Usta S, et al. Acinetobacter infection in a liver transplantation intensive care unit[J]. Transplant Proc, 2013, 45(3): 998-1000.
18. Singh N, Gayowski T, Wagener MM, et al. Pulmonary infiltrates in liver transplant recipients in the intensive care unit[J]. Transplantation, 1999, 67(8): 1138-1144.
19. Avkan-Oguz V, Ozkardesler S, Unek T, et al. Risk factors for early bacterial infections in liver transplantation[J]. Transplant Proc, 2013, 45(3): 993-997.
20. Li C, Mi K, Wen TF, et al. Risk factors and outcomes of massive red blood cell transfusion following living donor liver transplantation[J]. J Dig Dis, 2012, 13(3): 161-167.
21. Subramanian V, Bharat A, Vachharajani N, et al. Perioperative blood transfusion affects hepatitis C virus (HCV)-specific immune responses and outcome following liver transplantation in HCV-infected patients[J]. HPB (Oxford), 2014, 16(3): 282-294.
22. Benson AB, Burton JR, Austin GL, et al. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation[J]. Liver Transpl, 2011, 17(2): 149-158.
23. Lee S, Gj S, Kim SY, et al. Intraoperative predictors of early tracheal extubation after living-donor liver transplantation[J]. Korean J Anesthesiol, 2014, 67(2): 103-109.
24. Ikegami T, Shirabe K, Matono R, et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation[J]. Liver Transpl, 2012, 18(9): 1060-1068.

West China Medical Journal

Risk Factors for Fungal Infection in Adult Recipients Following Living Donor Liver Transplantation

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