Kodai Abe1, Masahiro Shinoda2,3, Shunsuke Uno4, Hideaki Obara1, Minoru Kitago1, Yuta Abe1, Tomoyuki Hishida1, Hiroshi Yagi1, Yasushi Hasegawa1, Yuko Kitagawa1. 1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. 2. Department of Surgery, Keio University School of Medicine, Tokyo, Japan. masa02114@yahoo.co.jp. 3. Digestive Diseases Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan. masa02114@yahoo.co.jp. 4. Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan.
Abstract
PURPOSE: Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. METHODS: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. RESULTS: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. CONCLUSIONS: Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.
PURPOSE:Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. METHODS: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. RESULTS: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. CONCLUSIONS:Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.
Authors: Ryan M Rivosecchi; Cornelius J Clancy; Ryan K Shields; Christopher R Ensor; Michael A Shullo; Bonnie A Falcione; Raman Venkataramanan; M Hong Nguyen Journal: Antimicrob Agents Chemother Date: 2017-08-24 Impact factor: 5.191