Invasive aspergillosis in liver transplant recipients in the antifungal targeted prophylaxis era

Ref ID: 17770

Author:

I. Hoyo, C. Cervera, M. Bartoletti, G. Sanclemente, L. Linares,
J. Puig de la Bellacasa, J. Colmenero, A. Escorsell, M. Navasa,
A. Moreno*

Author address:

Barcelona, ES)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Background: Invasive aspergillosis is a devastating complication
affecting liver transplantation. Risk factors have been widely
described and the use of antifungal prophylaxis seems to be justified
in high-risk scenarios. Our aim is to evaluate the characteristics and
incidence of IA in the era of antifungal targeted prophylaxis.
Methods: All liver transplants recipients from July 2003 to December
2009 were included. Pre, peri and post-transplant variables were
reviewed. Proven or probable invasive aspergillosis was defined
according to the EORTC/MSG. Categorical variables were compared
with the chi-square test or Fischer’s exact test. Backward step logistic
regression analysis was used for multivariate analysis.
Results: A total of 556 patients were evaluated. Overall, 135 patients
(24%) fulfilled criteria of high-risk LT, in whom 57 (42%) antifungal
prophylaxis was administered. In the study period, 16 patients developed
IA (3%) with mortality related to IA in eight patients (50%). According
to the presence of risk factors, 8.1% of high-risk LT developed IA vs
1.2% of patients without risk factors (p < 0.001). Five out of 16 cases of aspergillosis occurred in patients without criteria for high-risk LT. Most patients (38/59, 64%) received amphotericin B for antifungal prophylaxis. The incidence of IA from 2003 to 2009 was: 2.1%, 1.3%, 2.3%, 5.2%, 4.4%, 1.1%, 3.6% (p = 0.348). The species isolated from cases with IA were: A. fumigatus 11, A. terreus 4, A. niger 2, A. flavus 1 (two patients had coinfection with two species). Twelve cases of IA occurred in the first 3 months after transplantation of which 11 (fulfilling high risk criteria) could have been prevented with antifungal prophylaxis. Of these 12 patients, two received no prophylaxis, five intravenous amphotericin B, one nebulized amphotericin B, and two fluconazole. Breakthough aspergillosis occurred in five patients under prophylaxis with amphotericin B. A multivariate analysis adjusted by age and gender show that urgent transplantation (OR 9.2, 95%CI 2.2- 38.3) and post-transplant reoperation (OR 5.9, 95%CI 1.9-18.0) were the main risk factors for the development of IA. Conclusions: The incidence of IA in LT has not decreased along time. High-risk definitions for LT were associated with higher risk of IA. We detected 5 out of 12 preventable IA that occurred during or after prophylaxis with amphotericin. Reevaluation of antifungal prophylaxis in LT is warranted.

Abstract Number: P861

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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