RISK-FACTORS OF INVASIVE CANDIDA AND NON-CANDIDA FUNGAL-INFECTIONS AFTER LIVER-TRANSPLANTATION

Fungal infections are associated with a high mortality rate after live r transplantation. To describe risk factors for fungal infections, 405 consecutive liver transplant recipients were analyzed, Forty-five pat ients (11%) developed invasive fungal infection, Median posttransplant ation time to the first episode was 60 days, Pathogens were Candida sp ecies (spp) (n=24, 53%), Cryptococcus neoformans (n=10, 22%), Aspergil lus spp (n=6, 13%), Rhizopus spp (n=1), and others (n=4), Presentation s of infection included disseminated (n=9), intra-abdominal (n=9), eso phageal (n=9), lung (n=8), blood (n=6), and central nervous system inf ections (n=3), and sinusitis with esophagitis (n=1), Eighteen patients (40%) with invasive fungal infection died, and 13 (72%) of these deat hs were attributable to fungi, Mortality in the nonfungal infection gr oup was 12%. Univariate analysis identified separate risk factors for Candida (intra-abdominal bleeding), Aspergillus (fulminant hepatitis), and cryptococcal (symptomatic cytomegalovirus infection) infections, In both univariate and multivariate analyses, a high intratransplant t ransfusion requirement and posttransplant bacterial infection were ide ntified as significant risk factors for all types of fungal infection, The risk factor analysis reported here suggests that different pathog enic processes lead to Candida and non-Candida infection in liver tran splant recipients. Their identification should prompt specific prophyl actic measures to reduce morbidity and mortality in this population.