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Trends in invasive fungal infections over the decade in liver transplant recipients Correlation with evolution in transplantation practices



Trends in invasive fungal infections over the decade in liver transplant recipients Correlation with evolution in transplantation practices



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 41: 384-385



Background: The incidence of invasive fungal infections (inf.), particularly invasive candidiasis, after liver transplantation is strongly influenced by surgical factors and the technical complexity of the surgery. We assessed the temporal trends in invasive fungal inf. in the context of evolution in liver transplantation practices and other risk factors. Methods: Clinical characteristics of the patients, transplantation related variables, and rates of inf. were assessed in 190 consecutive liver transplant recipients over the last 10 years. No antifungal prophylaxis was employed. Trends for categorical data were evaluated using the Cochran-Armitage trend test and for continuous variables using ANOVA with linear contrast. Results: A decrease in operation time (p=0.03), blood transfusions (p=0.0001), cold ischemic time (p<.0001), use of roux-en-Y biliary anastomosis (p=0.0015), rate of biopsy proven rejection (p<.0001), and retransplantation (p=0.056) was documented over the years. The age of the recipients (p=0.0024) and the donors (p=0.005) increased, while the Child-Pugh score (p=0.02) and the proportion of patients transplanted as UNOS class 2a (p=0.0001) decreased over time. The incidence of CMV inf. remained unchanged. However, a significant increase in the frequency of primary CMV inf. (p=0.045), and a decrease in CMV disease (p=0.0006) was documented. Over the same time period, a significant decrease in the incidence of invasive candidiasis (p=0.015), and an insignificant increase in invasive aspergillosis (p=0.20) occurred. Conclusion: The frequency of invasive candidiasis in liver transplant recipients has declined significantly over the decade. Technical developments in transplantation practices and risk profiles of patients may have a role in influencing the evolving trends in fungal inf. in these patients.

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Accession: 035985398

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