RISK-FACTORS FOR INVASIVE FUNGAL-INFECTIONS COMPLICATING ORTHOTOPIC LIVER-TRANSPLANTATION

Risk factors for invasive fungal infection in patients undergoing orth otopic liver transplantation were examined. Thirty-four of 168 transpl ants were complicated within 100 days after transplantation by documen ted invasive fungal infection (Candida species, 28 patients; mycelial fungi, 5; both Candida and Aspergillus species, 1). In the multivariat e Cox proportional hazards model, three baseline and two posttransplan t variables were independently significant risk factors for infection: level of creatinine (hazard ratio = 1.4), length of transplant operat ion (HR = 1.2), retransplantation (HR = 3.2), abdominal or intrathorac ic reoperations (HR = 2.5), and cytomegalovirus infection (HR = 8.5). Four predictors (creatinine of >3.0 mg/dL, operative time of greater t han or equal to 11 h, retransplantation, and early colonization) asses sable at the time of transplantation or shortly thereafter were incorp orated into a simple predictive model for risk stratification. The ris k of invasive fungal infection ranged from 1% in patients with no pred ictors to 67% in patients with two or more predictors. Strategies to p revent invasive fungal infections after liver transplantation should b e targeted to these high-risk groups.