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February 1991

Clinical Spectrum of Fungal Infections After Orthotopic Liver Transplantation

Author Affiliations

From the Departments of Surgery (Drs Castaldo, Stratta, Wood, Langanas, Li, and Shaw and Mr Pillin), Pathology and Microbiology (Dr Markin), Family Practice (Dr Patil), Pharmacy Practice (Dr Shaefer), and Medicine (Dr Reed), University of Nebraska Medical Center, Omaha.

Arch Surg. 1991;126(2):149-156. doi:10.1001/archsurg.1991.01410260033005

• During a 50-month period, we identified 91 episodes of fungal infection in 72 liver transplant recipients (23.8%). Candida species accounted for 83.5% of cases. Clinical patterns of fungal infections included disseminated infection (19), peritonitis (17), pneumonitis (15), multiple sites of colonization (13), fungemia (11), and other sites (16). The diagnosis of fungal infection was usually made in the first 2 months (84.7% of cases), at a mean time of 16 days after transplantation. Risk factors for fungal infections included retransplantation, Risk score, intraoperative transfusion requirement, urgent status, Roux limb biliary reconstruction (in adults), steroid dose, bacterial infections and antibiotic therapy, and vascular complications. Fungal infections were successfully treated with amphotericin B in 63 cases (74.1%) but were associated with diminished patient survival (50% vs 83.5%). Fungal infection is a frequent source of early morbidity and can be related to well-defined risk factors, suggesting the need for effective prophylaxis.

(Arch Surg. 1991;126:149-156)