Farahani A, Ghiasvand F, Davoudi S, Ahmadinejad Z. Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality. World J Transplant 2023; 13(5): 264-275 [PMID: 37746042 DOI: 10.5500/wjt.v13.i5.264]
Corresponding Author of This Article
Zahra Ahmadinejad, MD, Full Professor, Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, KESHAVARZ Blvd, Dr Gharib Street, Tehran 1478714466, Iran. ahmadiz@tums.ac.ir
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
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The pretransplant episode of documented bacterial peritonitis
3 (13.6%)
5 (13.2%)
0.9
-
Previous systemic antibiotic use of more than 14 consecutive days
5 (22.7%)
6 (15.8%)
0.51
-
Re transplantation
5 (22.7%)
3 (7.9%)
0.13
-
Table 2 Clinical and laboratory information of patients with invasive aspergillus infection1
Covariate
Number (percent)
Diagnosis (proven)
9 (40.9%)
Diagnosis (probable)
13 (59.1%)
Site of diagnosis (isolated pulmonary)
19 (86.4%)
Site of diagnosis (isolated sinusitis)
2 (9.1%)
Site of diagnosis (peritonitis)
1 (4.5%)
Positive galactomannan (serum)
5 (22.7%)
Positive galactomannan (BAL)
8 (36.4%)
Positive galactomannan (N/A)
9 (40.9%)
PCR (positive)
8 (36.4%)
PCR (negative)
3 (13.6%)
PCR (N/A)
11 (50%)
Pathology (positive)
2 (9.1%)
Pathology (negative)
4 (18.2%)
Pathology (N/A)
16 (72.7%)
Fungal culture (positive)
10 (45.5%)
Fungal culture (negative)
2 (9.1%)
Fungal culture (N/A)
10 (45.5%)
Site of positive culture (sputum)
2 (9.1%)
Site of positive culture (BAL)
6 (27.3%)
Site of positive culture (sinus biopsy)
4 (18.2%)
Site of positive culture (pulmonary biopsy)
1 (4.5%)
Site of positive culture (peritonitis)
1 (4.5%)
CT scan findings (nodules)
11 (50%)
CT scan findings (ground glass opacity)
2 (9.1%)
CT scan findings (halo sign)
10 (45.5%)
CT scan findings (consolidation)
5 (22.7%)
CT scan findings (cavity)
3 (13.6%)
CT scan findings (pleural effusion)
7 (31.8%)
Treatment response at 6 & 12 wk (cure)
10 (45.5%)
Treatment response at 6 & 12 wk (partial response)
4 (18.2%)
Treatment response at 6 & 12 wk (stable)
-
Treatment response at 6 & 12 wk (progression)
-
Treatment response at 6 & 12 wk (death)
8 (36.4%)
12- month mortality
10 (4.45%)
Table 3 Comparison of factors related to the transplant of the study population
Covariate
Case
Control
P value
OR (95%CI)
Type of anastomosis (duct to duct)
16 (72.7%)
30 (78.9%)
0.53
-
Type of anastomosis (Roux-en-Y)
6 (27.3%)
8 (21.1%)
0.53
-
Cold ischemic time (h)
283.95 (66.58)
300.37 (58.39)
0.32
-
Underlying disease (NASH)
6 (27.3%)
6 (15.8%)
0.74
-
Underlying disease (PSC)
3 (13.6%)
8 (21.1%)
0.74
-
Underlying disease (HBV)
3 (13.6%)
5 (13.2%)
0.74
-
Underlying disease (HCV)
2 (9.1%)
1 (2.6%)
0.74
-
Underlying disease (AIH)
1 (4.5%)
3 (7.9%)
0.74
-
Underlying disease (AIH & HCC)
1 (4.5%)
1 (2.6%)
0.74
-
Underlying disease (HCV & NASH)
1 (4.5%)
-
0.74
-
Underlying disease (PBC)
1 (4.5%)
-
0.74
-
Underlying disease (Others)
4 (18.1%)
5 (13.2%)
0.74
-
Underlying disease (ASH)
-
2 (5.3%)
0.74
-
Underlying disease (HCV & HCC)
-
2 (5.3%)
0.74
-
Underlying disease (NASH & HCC)
-
2 (5.3%)
0.74
-
Underlying disease (NASH & PSC)
-
1 (2.6%)
-
-
Underlying disease (HBV & HCC)
-
1 (2.6%)
-
-
Underlying disease (Wilson)
-
1 (2.6%)
-
-
Intraoperative blood transfusion
3.45 (3.05)
2.5 (2.57)
0.2
-
Induction therapy (ATG)
8 (36.4%)
6 (15.8%)
< 0.001
0.08 (0.02-0.41)
Induction therapy (methyl prednisolon)
14 (63.6%)
32 (84.2%)
< 0.001
0.05 (0.01-0.25)
Biliary leak post-transplant
9 (40.9%)
-
< 0.001
-
Reoperation within 30 d of transplant
12 (54.5%)
5 (13.2%)
< 0.001
7.92 (2.25-27.94)
Hepatic artery thrombosis post-transplant
8 (36.4%)
1 (2.6%)
< 0.001
21.14 (2.42-184.79)
Table 4 Comparison of the post-transplant factors in the study population
Covariate
Case
Control
P value
OR (95%CI)
Antifungal prophylaxis after transplant (Fluconazole)
10 (45.5%)
13 (34.2%)
0.003
0.20 (0.05-0.85)
Antifungal prophylaxis after transplant (voriconazole)
9 (40.9%)
5 (13.1%)
0.08 (0.02-0.43)
Antifungal prophylaxis after transplant (no)
3 (13.6%)
20 (52.7%)
-
Bacteremia within 2 wk before diagnosis
3 (13.6%)
4 (10.5%)
0.70
-
Pneumonia within 2 wk before diagnosis
13 (59.1%)
4 (10.5%)
< 0.001
0.08 (0.02-0.31)
Systemic antibacterial within 2 wk before diagnosis
16 (72.7%)
15 (39.5%)
< 0.001
4.09 (1.31-12.81)
Dialysis requirement
7 (31.8%)
4 (10.5%)
0.08
CMV viremia before diagnosis
9 (40.9%)
4 (10.5%)
0.009
5.89 (1.54-22.47)
CMV diseases before diagnosis
3 (13.6%)
2 (5.3%)
0.35
Length of ICU stay at the time of transplant
4.05 (3.59)
1.75 (1.20)
0.008
0.56 (0.38-0.82)
Duration of mechanical ventilation at the time of transplant
1.25 (0.55)
1.12 (0.41)
0.34
Creatinine at the day of diagnosis (highest value)
1/87 (SD:1/1)
1/21 (SD:1/43)
-
-
Table 5 Rejection before and after diagnosis of invasive aspergillosis
Covariate
Case
Control
P value
OR (95%CI)
Rejection requiring treatment within 3 mo before diagnosis
13 (59.1%)
10 (26.3%)
0.01
4.04 (1.33-12.34)
Rejection required treatment after diagnosis
4 (18.2%)
4 (10.5%)
0.45
-
Citation: Farahani A, Ghiasvand F, Davoudi S, Ahmadinejad Z. Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality. World J Transplant 2023; 13(5): 264-275