Liver Transplantation in Patients With Pretransplant Aspergillus Colonization: Is It Safe to Proceed?
| Autor: | Robert McMillan, Lisa Quach, Joseph DiNorcia, Douglas G. Farmer, Ronald W. Busuttil, Alfonso Molina, Arpit Amin, Drew J. Winston, Takahiro Ito, Vatche G. Agopian, Fady M. Kaldas |
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| Rok vydání: | 2020 |
| Předmět: |
Voriconazole
Transplantation medicine.medical_specialty Echinocandin business.industry medicine.medical_treatment Mucormycosis 030230 surgery Liver transplantation Aspergillosis medicine.disease Gastroenterology Intensive care unit law.invention 03 medical and health sciences Liver disease 0302 clinical medicine law Internal medicine Medicine 030211 gastroenterology & hepatology business medicine.drug |
| Zdroj: | Transplantation. 105:586-592 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003276 |
| Popis: | BACKGROUND Patients with end-stage liver disease and pretransplant Aspergillus colonization are problematic for determining liver transplant candidacy and timing of transplantation because of concerns for posttransplant invasive aspergillosis. METHODS We performed a retrospective review of the medical and laboratory records of all adult patients (aged ≥18 y) who underwent liver transplantation with pretransplant Aspergillus colonization at the Ronald Reagan University of California, Los Angeles, Medical Center from January 1, 2010, to December 31, 2015. RESULTS A total of 27 patients who had Aspergillus colonization (respiratory tract 26, biliary tract 1) before liver transplantation were identified. Pretransplant characteristics included previous liver transplant (11 of 27, 40.7%), dialysis (22 of 27, 81.5%), corticosteroid therapy (12 of 27, 44.4%), intensive care unit stay (27 of 27, 100%), and median model for end-stage liver disease score of 39. Only 22.2% (6 of 27) received pretransplant antifungal agents (median duration, 5 d), whereas 100% (27 of 27) received posttransplant antifungal prophylaxis (voriconazole 81.4%, 22 of 27; echinocandin 14.8%, 4 of 27; voriconazole plus echinocandin 3.7%, 1 of 27) for median duration of 85 d. Posttransplant invasive fungal infection occurred in 14.8% (4 of 27; aspergillosis 3, mucormycosis 1). Both 6-month and 12-month survival were 66.7% (18 of 27), but only 1 death was due to fungal infection. Other causes of death were liver graft failure, intraabdominal complications, and malignancy. CONCLUSIONS A substantial number of patients with pretransplant Aspergillus colonization can still undergo successful liver transplantation if they are otherwise suitable candidates and receive appropriate antifungal prophylaxis. Posttransplant outcome in these patients is determined mostly by noninfectious complications and not fungal infection. Pretransplant Aspergillus colonization alone should not necessarily preclude or delay liver transplantation. |
| Databáze: | OpenAIRE |
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