Aspergillosis is a potential, severe, and usually early complication of liver transplantation.
New strategies, such as detecting Aspergillus antigenemia, have been used for the diagnosis of aspergillosis in immunosuppressed patients, but the impact in solid organ transplantation is not well known.
In this case-control study, a team of researchers from Madrid, Spain assessed 260 adults who underwent liver transplantation between 1994 and 2000.
The team defined a case as any liver transplant recipient with a proven, or probable, diagnosis of invasive aspergillosis.
Whereas, controls were defined as a liver transplant recipient without aspergillosis infection, and with posttransplant survival longer than 2 months.
The team compared both the clinical and analytical variables, including Aspergillus antigenemia.
A separate analysis was performed where aspergillosis developed after day 100 posttransplantation.
Among the 260 patients assessed, invasive aspergillosis developed in 15.
The team determined the median time from transplantation to aspergillosis in 13 patients to be 126 days.
Of these 13 patients, 54% developed the infection after day 100 posttransplantation.
|54% developed aspergillosis infection after day 100, posttransplantation.|
There were 38 control patients.
Antigenemia was available in 9 of the 13 cases, as well as in 33 of 38 controls.
Multivariate analysis identified retransplantation, dialysis requirements after transplantation, and the presence of Aspergillus antigenemia in serum at any time after transplantation as independent factors associated with aspergillosis.
The team found that, in the subgroup of patients who developed late aspergillosis, cytomegalovirus infection was the only associated independent factor.
Dr Jesús Fortún's team concluded, "Hepatic and renal dysfunction predispose to Aspergillus infection in liver transplant recipients".
"Cytomegalovirus infection and increased immunosuppression favor invasive aspergillosis during the late posttransplantation period".
"Aspergillus antigenemia seems to be a good predictor of invasive aspergillosis".
In a related editorial, in the same publication, Dr Nina Singh, from Pittsburgh, Pennsylvania, USA, discusses the significance of invasive aspergillosis infection in transplant recipients".
Dr Singh comments that the, "Changing epidemiological characteristics of invasive aspergillosis in liver transplant recipients have implications relevant for identifying high-risk patients…[and for] optimal management of invasive infection caused by Apergillus species.