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Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era
Author(s) -
Saliba Faouzi,
Delvart Valérie,
Ichaï Philippe,
Kassis Najiby,
Botterel Françoise,
Mihaila Liliana,
Azoulay Daniel,
Adam René,
Castaing Denis,
Bretagne Stéphane,
Samuel Didier
Publication year - 2013
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12129
Subject(s) - medicine , liver transplantation , gastroenterology , incidence (geometry) , retrospective cohort study , antifungal , mycosis , transplantation , relative risk , liver disease , surgery , confidence interval , physics , dermatology , optics
Antifungal prophylaxis is recommended in high‐risk patients, but risk criteria remain unclear and the predictive value of Model of End‐Stage Liver Disease ( MELD ) score is unknown. In a retrospective, single‐center analysis of 667 liver transplants, potential risk factors for fungal infection were assessed, including MELD score. Antifungal prophylaxis was administered in 198 patients (29.4%). During follow‐up (mean 43.6 ± 29.6 months), 263 patients (39.4%) developed ≥1 episode of fungal infection, and 187 (28.0%) patients developed a probable or proven invasive fungal infection requiring systemic antifungal treatment. Patients receiving antifungal prophylaxis had a lower incidence of fungal infection (29.8% vs. 43.5% without prophylaxis, p < 0.001) and invasive fungal infection (17.7% vs. 32.4%, p < 0.001). One‐yr patient survival was 91%, 85% and 69%, respectively, in patients with no fungal infection, fungal colonization and treated invasive fungal infection (p < 0.001); graft survival was 88%, 85% and 66% (p < 0.001). Multivariate analysis indicated that MELD score of 20–30 or ≥30 was associated with a 2.0‐fold or 4.3‐fold increase in relative risk of fungal infection, respectively, and a 2.1‐fold or 3.1‐fold increase in relative risk of invasive fungal infection. In conclusion, liver transplant patients with a MELD score ≥20, and particularly patients with a score ≥30, are candidates for antifungal prophylaxis.