Aspergillosis in Liver Transplant Recipients
Background: Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.
Methods: We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center.
Results: A diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary involvement; 1 presented with an inguinal mass. Time from transplant to infection ranged from 1 week to 34 months. Treatment included surgical intervention and medical treatment. All patients infected with Aspergillus fumigatus were treated with a sequential protocol of lipid complex amphotericin followed by itraconazole. The major side effect of treatment was worsening renal function. One patient died of intracranial hemorrhage during treatment.
Conclusion: Successful treatment of aspergillosis in liver transplant recipients should include early diagnosis, sequential medical treatment with lipid amphotericin B and itraconazole, and surgical intervention for invasive disease.
Liver transplant recipients are at high risk of infection with Aspergillus species, which may cause invasive disease and severe complications in this patient population. Risk factors are a high degree of immunosuppression, use of muromonab-CD3 (OKT3), need for retransplantation, history of smoking, and renal insufficiency. Single-center studies report an aspergillosis prevalence of approximately 1.5%, but the mortality rate has been reported to be higher than 90%.
New antifungal agents are now available; in particular, lipid formulations of amphotericin B, such as amphotericin B colloidal dispersion, amphotericin B lipid complex, and liposomal amphotericin B, are equally effective and less toxic. The overall impact of treatment with these new antifungal agents on aspergillosis at a single transplant center is not known. We performed a study at our center to see whether a multistep approach, using combined treatment, was effective in improving the outcome of patients with this infectious complication.
Background: Invasive aspergillosis is a life-threatening complication in liver transplant recipients, with a reported mortality rate of more than 90%. Treatment is difficult, and no single agent is uniformly effective in treating this patient population.
Methods: We retrospectively reviewed all fungal cultures from 200 liver transplant patients between 1996 and 1999 at a single tertiary referral center.
Results: A diagnosis of aspergillosis was made in 6 patients. Five patients had pulmonary involvement; 1 presented with an inguinal mass. Time from transplant to infection ranged from 1 week to 34 months. Treatment included surgical intervention and medical treatment. All patients infected with Aspergillus fumigatus were treated with a sequential protocol of lipid complex amphotericin followed by itraconazole. The major side effect of treatment was worsening renal function. One patient died of intracranial hemorrhage during treatment.
Conclusion: Successful treatment of aspergillosis in liver transplant recipients should include early diagnosis, sequential medical treatment with lipid amphotericin B and itraconazole, and surgical intervention for invasive disease.
Liver transplant recipients are at high risk of infection with Aspergillus species, which may cause invasive disease and severe complications in this patient population. Risk factors are a high degree of immunosuppression, use of muromonab-CD3 (OKT3), need for retransplantation, history of smoking, and renal insufficiency. Single-center studies report an aspergillosis prevalence of approximately 1.5%, but the mortality rate has been reported to be higher than 90%.
New antifungal agents are now available; in particular, lipid formulations of amphotericin B, such as amphotericin B colloidal dispersion, amphotericin B lipid complex, and liposomal amphotericin B, are equally effective and less toxic. The overall impact of treatment with these new antifungal agents on aspergillosis at a single transplant center is not known. We performed a study at our center to see whether a multistep approach, using combined treatment, was effective in improving the outcome of patients with this infectious complication.
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