Kawagishi Naoki, Satoh Kazushige, Enomoto Yoshitaka, Akamatsu Yorihiro, Sekiguchi Satoshi, Fujimori Keisei, Satomi Susumu
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Tohoku J Exp Med. 2006 Jul;209(3):207-15. doi: 10.1620/tjem.209.207.
Invasive fungal infection is a fatal complication in liver transplantation and it is very difficult to diagnose at the early stage. The aim of this study was to review our experience with invasive fungal infections in living donor liver transplantation (LDLT) and to analyze the risk factors and the impact of beta-D glucan. From 1991 to 2005, 96 LDLTs were performed in our institution and we measured the serum level of beta-D glucan in order to clarify the diagnosis. Invasive fungal infection was diagnosed based on clinical symptoms, culture, radiological evidence and beta-D glucan. Active fungal infection was treated with fluconazole, amphotericin B, flucytosine and micafungin. Risk factors both pre- and post- LDLT were analyzed. Candida albicans was the most frequently isolated species (70%). The risk factors identified by univariate analysis include the following four conditions: acute blood purification (plasma exchange with or without continuous hemodiafiltration), hepatic vein complications, renal failure and respiratory failure. By logistic regression analysis, hepatic vein complications and respiratory failure were identified as independent risk factors. The risk factors for invasive fungal infection of LDLT in Japan have not been well analyzed and this report will provide valuable information for the prevention of the fungal infection.
侵袭性真菌感染是肝移植中的一种致命并发症，且在早期很难诊断。本研究的目的是回顾我们在活体肝移植（LDLT）中处理侵袭性真菌感染的经验，并分析危险因素以及β-D葡聚糖的影响。1991年至2005年，我们机构共进行了96例活体肝移植手术，我们检测了血清β-D葡聚糖水平以明确诊断。侵袭性真菌感染根据临床症状、培养、影像学证据及β-D葡聚糖进行诊断。活动性真菌感染采用氟康唑、两性霉素B、氟胞嘧啶及米卡芬净进行治疗。分析了活体肝移植术前及术后的危险因素。白色念珠菌是最常分离出的菌种（70%）。单因素分析确定的危险因素包括以下四种情况：急性血液净化（伴有或不伴有持续血液透析滤过的血浆置换）、肝静脉并发症、肾衰竭及呼吸衰竭。通过逻辑回归分析，肝静脉并发症及呼吸衰竭被确定为独立危险因素。日本活体肝移植侵袭性真菌感染的危险因素尚未得到充分分析，本报告将为预防真菌感染提供有价值的信息。
