活体肝移植术后侵袭性真菌感染的风险分析：哪些患者需要强效预防措施？

Risk Analysis for Invasive Fungal Infection after Living Donor Liver Transplantation: Which Patient Needs Potent Prophylaxis?

作者信息

Utsumi Masashi, Umeda Yuzo, Yagi Takahito, Nagasaka Takeshi, Shinoura Susumu, Yoshida Ryuich, Nobuoka Daisuke, Kuise Takashi, Fuji Tomokazu, Takagi Kosei, Takaki Akinobu, Fujiwara Toshiyoshi

机构信息

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.

Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama,

出版信息

Dig Surg. 2019;36(1):59-66. doi: 10.1159/000486548. Epub 2018 Apr 12.

DOI:10.1159/000486548

PMID:29649828

Abstract

BACKGROUND

Invasive fungal infection (IFI) is associated with high mortality after living donor liver transplant (LDLT). The aim of this study was to identify the risk factors for post-LDLT IFI for early diagnosis and improvement of antifungal treatment outcome.

METHODS

Risk analysis data were available for all 153 patients who underwent LDLT between January 2005 and April 2012.

RESULTS

During the follow-up period (1,553 ± 73 days, range 20-2,946 days), 15 patients (9.8%) developed IFI classified as "proven" (n = 8) and "probable" (n = 7) with fungal pathogens including Candida spp. (n = 10), Aspergillus spp. (n = 4), and Trichosporon (n = 2). Of these patients, 7 patients with IFI died despite treatment. The 1-, 3-, and 5-year survival rates were lower in patients with IFI than those without IFI (66.7/59.3/44.4 vs. 90.4/85.7/81.8%, respectively; p = 0.0026). Multivariate analysis identified model for end-stage liver disease score of ≥26 (OR 16.0, p = 0.0012) and post-transplant acute kidney injury (RIFLE criteria I- or F-class; OR 4.87, p = 0.047) as independent risk factors for IFI.

CONCLUSION

Preoperative recipients' status and postoperative kidney dysfunction can affect an occurrence of post-transplant IFI. These risk factors would be taken into consideration for designation of proper antifungal therapy.

摘要

背景

侵袭性真菌感染（IFI）与活体肝移植（LDLT）后的高死亡率相关。本研究的目的是确定LDLT后IFI的危险因素，以便早期诊断并改善抗真菌治疗效果。

方法

对2005年1月至2012年4月期间接受LDLT的153例患者的风险分析数据进行了分析。

结果

在随访期（1553±73天，范围20 - 2946天）内，15例患者（9.8%）发生了IFI，分类为“确诊”（n = 8）和“拟诊”（n = 7），真菌病原体包括念珠菌属（n = 10）、曲霉属（n = 4）和毛孢子菌属（n = 2）。在这些患者中，7例IFI患者尽管接受了治疗仍死亡。IFI患者的1年、3年和5年生存率低于未发生IFI的患者（分别为66.7/59.3/44.4% 对 90.4/85.7/81.8%；p = 0.0026）。多因素分析确定终末期肝病评分≥26（比值比16.0，p = 0.0012）和移植后急性肾损伤（RIFLE标准I级或F级；比值比4.87，p = 0.047）为IFI的独立危险因素。