AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
Clin Transplant. 2013 Jul-Aug;27(4):E454-61. doi: 10.1111/ctr.12129. Epub 2013 May 9.
Antifungal prophylaxis is recommended in high-risk patients, but risk criteria remain unclear and the predictive value of Model of End-Stage Liver Disease (MELD) score is unknown. In a retrospective, single-center analysis of 667 liver transplants, potential risk factors for fungal infection were assessed, including MELD score. Antifungal prophylaxis was administered in 198 patients (29.4%). During follow-up (mean 43.6 ± 29.6 months), 263 patients (39.4%) developed ≥ 1 episode of fungal infection, and 187 (28.0%) patients developed a probable or proven invasive fungal infection requiring systemic antifungal treatment. Patients receiving antifungal prophylaxis had a lower incidence of fungal infection (29.8% vs. 43.5% without prophylaxis, p < 0.001) and invasive fungal infection (17.7% vs. 32.4%, p < 0.001). One-yr patient survival was 91%, 85% and 69%, respectively, in patients with no fungal infection, fungal colonization and treated invasive fungal infection (p < 0.001); graft survival was 88%, 85% and 66% (p < 0.001). Multivariate analysis indicated that MELD score of 20-30 or ≥ 30 was associated with a 2.0-fold or 4.3-fold increase in relative risk of fungal infection, respectively, and a 2.1-fold or 3.1-fold increase in relative risk of invasive fungal infection. In conclusion, liver transplant patients with a MELD score ≥ 20, and particularly patients with a score ≥ 30, are candidates for antifungal prophylaxis.
抗真菌预防治疗推荐用于高危患者，但风险标准仍不明确，且终末期肝病模型（MELD）评分的预测价值未知。在一项回顾性、单中心的 667 例肝移植分析中，评估了真菌感染的潜在危险因素，包括 MELD 评分。198 例患者（29.4%）接受了抗真菌预防治疗。在随访期间（平均 43.6±29.6 个月），263 例患者（39.4%）发生了≥1 次真菌感染，187 例（28.0%）患者发生了需要全身抗真菌治疗的疑似或确诊侵袭性真菌感染。接受抗真菌预防治疗的患者真菌感染发生率较低（29.8% vs. 无预防治疗者的 43.5%，p<0.001）和侵袭性真菌感染发生率较低（17.7% vs. 32.4%，p<0.001）。无真菌感染、真菌定植和治疗性侵袭性真菌感染患者的 1 年患者生存率分别为 91%、85%和 69%（p<0.001）；移植物生存率分别为 88%、85%和 66%（p<0.001）。多变量分析表明，MELD 评分 20-30 或≥30 与真菌感染的相对风险分别增加 2.0 倍或 4.3 倍，侵袭性真菌感染的相对风险分别增加 2.1 倍或 3.1 倍。总之，MELD 评分≥20 的肝移植患者，尤其是评分≥30 的患者，是抗真菌预防治疗的候选者。
