Outcomes of Invasive Aspergillosis in Liver Transplant Recipients From an Institution Using Targeted Antifungal Prophylaxis and an Antifungal Stewardship Program.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-05-12 DOI:10.1111/tid.70046

Brennan Collis, Karen Urbancic, Jack Whitelaw, Gemma Reynolds, Sara Vogrin, Hossein Jahanabadi, Dinesh Pandey, Marie Sinclair, Avik Majumdar, Adam Testro, Jason A Trubiano, Olivia C Smibert

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引用次数: 0

Abstract

Background: Recent evidence suggests liver transplant recipients (LiTRs) with invasive aspergillosis (IA) have lower rates of dissemination and mortality compared to historical data. However, contemporary data from other centers remain scarce. We aimed to evaluate modern IA outcomes at our institution, where targeted perioperative echinocandin prophylaxis and an active antifungal stewardship program (AFSP) have been implemented.

Methods: This is a single-center retrospective analysis of patients who underwent liver transplantation between January 1, 2017 and June 30, 2022. During the study period, targeted anidulafungin perioperative prophylaxis was administered to patients considered high-risk for invasive fungal infection (IFI), and a multidisciplinary AFSP assisted with IFI diagnosis and management. Patients with proven and probable IA diagnosed post-operatively were identified using internationally accepted definitions. The primary outcomes were IA dissemination and 1-year all-cause mortality rates. Data were extracted from the electronic medical record and descriptive summary statistics were performed.

Results: Six patients (6/377, 1.6%) met the inclusion criteria. Patients with IA were significantly more likely to be colonized with multidrug-resistant Gram-negative organisms compared to those without IA (50.0% vs. 12.1%, p = 0.006). The median time to IA diagnosis was 22 days post-transplant (IQR 5-109). No cases of dissemination were observed. One-year all-cause mortality was 16.7%.

Conclusion: Consistent with contemporary data, LiTRs had lower IA dissemination and mortality rates compared to earlier studies. These improved outcomes likely reflect a combination of modern advancements in liver transplantation, and we highlight two potentially modifiable interventions; targeted echinocandin prophylaxis and an AFSP. Further studies are needed to support their broader implementation.

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使用靶向抗真菌预防和抗真菌管理计划的机构肝移植受者侵袭性曲霉病的结果。

背景：最近的证据表明，与历史数据相比，肝移植受者（LiTRs）侵袭性曲霉病（IA）的传播率和死亡率较低。然而，来自其他中心的当代数据仍然很少。我们的目的是评估我们机构的现代IA结果，其中有针对性的围手术期棘白菌素预防和主动抗真菌管理计划（AFSP）已经实施。方法：对2017年1月1日至2022年6月30日期间接受肝移植的患者进行单中心回顾性分析。在研究期间，对侵袭性真菌感染（IFI）高危患者给予靶向anidulafunin围手术期预防，并采用多学科AFSP辅助IFI诊断和治疗。术后确诊和可能诊断为IA的患者使用国际公认的定义进行识别。主要结局是IA传播和1年全因死亡率。数据从电子病历中提取，并进行描述性汇总统计。结果：6例患者（6/ 3777,1.6%）符合纳入标准。与没有IA的患者相比，IA患者更有可能被多重耐药革兰氏阴性菌定植（50.0%比12.1%,p = 0.006）。到IA诊断的中位时间为移植后22天（IQR 5-109）。未观察到传播病例。一年全因死亡率为16.7%。结论：与当代数据一致，与早期研究相比，LiTRs的IA传播和死亡率较低。这些改善的结果可能反映了现代肝移植技术的进步，我们强调了两种潜在的可修改干预措施；靶向棘白菌素预防和AFSP需要进一步研究以支持其更广泛的实施。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.