Invasive Fungal Infections after Liver Transplantation

Abstract

L iver transplantation is one of the most effective therapeutic options for patients with certain acute and chronic end-stage liver diseases, such as acute liver failure, hepatocellular carcinoma and severe hepatitis. The steady increase in the number of liver transplant recipients means hospitals are treating more immunocompromised patients; this can be associated with increased infection-related morbidity and mortality and higher hospital care costs. Fungal infections are well-recognized, lifethreatening complications of liver transplantation. Delayed diagnosis of fungal infections is a major complicating factor as symptoms are not specific, and even patients with disseminated disease in multiple organ might not present with organ-specific changes or clinical signs So fungal infections can be the major factor associated with a poor prognosis in liver transplant recipients. Candida species are the most common, followed by aspergillus species. The mortality associated with these infections ranges from 25% to 69%. However, Aspergillus-associated mortality has been found to approach 100% if untreated. Given the high incidence and mortality rate of fungal infections after liver transplantation, the identification of risk factors and antifungal prophylactic agents is necessary and urgent. Although most fungal infections are caused by candida species, infections by aspergillus species have increased significantly in recent years and are associated with poor outcomes.