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Incidence of invasive fungal infection in adult liver transplant recipients in the intensive care unit: a prospective validation of a risk stratification scheme

Abstract number: P1422

del Palacio A., Cuétara M.S., Alvarez M.E., Alhambra A., Catalán M., Montejo J.C., Pontón J.

Objective: Hellinger et al (Liver Transpl 2005; 11:656) proposed a risk group stratification of invasive fungal disease (IFD) in adult liver transplant recipients (LTR). Our aim was to prospectively validate this proposal in LTR requiring mechanical ventilation in the intensive care unit (ICU) and the relationship between the incidence of IFD (per patient) and risk group.

Methods: Patients were stratified into 3 groups: (1) High risk LTR were patients on haemodialysis at the time of transplantation or with delay of hospital discharge beyond day 7 after transplantation due to allograft or renal insufficiency; (2) Intermediate risk – retransplantation or transplantation due to fulminant hepatic failure; (3) Low risk – absence of conditions in groups 1 and 2. Conventional diagnostic methods, biomarkers (Galactomannan, (1–3)-B-D-glucan), tissue biopsies and necropsies, with the assessment of risk factors, signs, symptoms and radiologic imaging were used for the diagnosis of IFD as defined by De Pauw et al (Clin Infect Dis 2008; 46: 1813).

Results: 43 adult LTR requiring ICU admission were prospectively studied. Evidence of IFD was documented in 8 patients (6 proven and 2 probable cases). The incidence of IFD in the high risk group was 29.6% (8/27) whilst the incidence of the intermediate and low risk groups was nil. The mortality in the IFD group was 62% (5/8) and in the nonIFD group was 42.85% (15/35). The rate of necropsies was 45% (9/20).

Conclusions: Our current data showed that the risk stratification scheme described and proposed by Hellinger et al is a valid method for identifying in the clinical setting those LTR patients at highest risk of developing IFD. In conclusion, readily identifiable patient characteristics can be used to stratify LTR for risk of developing IFD. Prospective studies with antifungal targeted prophylaxis given to high risk LTR may provide if this approach could lead to cost-effective prevention of IFD.

Acknowledgments: This investigation was supported by grants Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Proyecto Investigacion PI 070134 (to MSC), PI 070107 (to A d P) and PI 070376 (to JP), grant IT-26407 of Departamento de Educacion, Universidades e Investigacion del Gobierno Vasco (to JP) and Saiotek from Departamento de Industria, Comercio y Turismo del Gobierno Vasco (to JP) and an Educational grant from Pfizer (to A d P) and Gilead Spain (to A d P).

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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