FUNGAL-INFECTIONS IN LIVER-TRANSPLANT RECIPIENTS

A retrospective analysis of 462 consecutive orthotopic liver transplan tations was undertaken to evaluate incidence, risk factors, clinical c ourse, and outcome of fungal infections. Infections involving Aspergil lus (6 cases), Candida (5 cases), Mucor (1 case), and Cryptococcus (1 case) were observed in 2.8% (13/462) of our patients. Tweleve of the 1 3 episodes developed during the first 2 post-operative months. None of the potential risk factors for fungal infections described by other a uthors (i.e., age, rejection treatment, dialysis, mechanical ventilati on, graft failure, long operation time, second transplant, serious non -fungal infection) correlated significantly with the episodes in our p atients. However, in patients who exhibited three or more of these pot ential risk factors the incidence of fungal infections was elevated (P <0.001). Six of seven exogeneous infections (Aspergillus, Mucor) began before July 1991 when our department moved from Charlottenburg to Wed ding, thus indicating that the incidence of these infections is highly influenced by exposure (P = 0.01). Exposure prophylaxis should theref ore by meticulously followed, particularly when severely compromised p atients are involved, in order to prevent exogenous infections (i.e. A spergillus/Mucor). Infections involving such patients are combined wit h a very high mortality (57%). We observed Candida infection as a path ological overgrowth of physiological oropharynx flora into the esophag us and/or trachail. in five patients. In each case treatment led to fu ll recovery.