411. Invasive Fungal Infections in Liver Transplant Recipients 2003-2007: Incidence, mortality and risk factors
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Background: Invasive Fungal Infections (IFI) increase mortality in orthotopic liver transplant (OLT) recipients. Risk factors for IFI have been reported, but recent surgical trends, antifungal use and emergence of non-albicans Candida sp may impact the incidence and outcomes of IFI in OLT.
Methods: We retrospectively reviewed hospital records for all OLT recipients at our institution between Jan 2003 and Dec 2007. IFI was defined as histopathological evidence of fungal infection or positive culture from sterile site. Fluconazole prophylaxis was routinely used in high risk OLT recipients. Statistical analysis was performed using SPS software version 17.013.
Results: Of 554 OLT recipients, 91(16%) developed IFI. Non-albicans Candida accounted for 58.4%. Survival at 1yr was significantly lower in the IFI vs non-IFI groups, 40.7 vs 79.7%(p< 0.0001), and in non-albicans vs albicans groups 30.2% vs 68.4%(p<0.007). On univariate analysis, MELD >25, DRI(donor risk index)<1.7, biliary complications, re-exploration, prior steroid use, prior ICU stay, fluconazole prophylaxis and prior fungal colonization were all significantly associated with IFI. Fluconazole prophylaxis was significantly associated with non-albicans IFI(p<0.005). On multivariate analysis, DRI <1.7, biliary complications, prior steroid use and prior fungal colonization were significantly associated with IFI.
Conclusion: IFI significantly lowers survival in a recent population of OLT recipients. Non-albicans Candida species now account for the majority of IFI and most substantially impact survival. IFI continues to be associated with many previously recognized risk factors. However, fluconazole prophylaxis did not appear to prevent IFI and may have predisposed to non-albicans IFI. In light of these findings, redefining risk and appropriate prophylactic strategies may be necessary. The correlation of low DRI with IFI is of unclear significance and will require further study.
Christine Koval, MD1, Mark Orloff, MD1, Anupama Raghuram, MD2, Saman Safadjou, MD1 and  A. Raghuram, None..
S. Safadjou, None..
M. Orloff, None..
C. Koval, None., (1)University of Rochester Medical Center, Rochester, NY, (2)University of Rochester Medical Center, Pittsford, NY