Invasive Fungal Infections In Liver Transplant Patients

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Transplants of vital organs like liver, heart, kidney, and bone marrow can be very helpful to patients and often provide decades of additional relatively healthy life. However, the use of immunosuppressive drugs to prevent organ rejection makes these patients very susceptible to life threatening fungi (mold) infections-especially from Candida and Aspergillus.  

Xia Liu et al. Invasive fungal transplantation in liver transplantation. International Journal of Infectious Diseases 2011;15:e298-e304.
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Allon Kahn et al. Universal fungal prophylaxis and risk of coccidioidomycosis in liver transplant patients living in an endemic area. Liver Transplantation, 2015; In Press.

Various published studies have reported that between 5 to 42% of liver transplant patients develop at least one invasive fungal infection after transplantation, with a mortality rate of between 25 and 69% for each of these fungal infections. The most common fungal infections in liver transplant patients are Candida (about 65% of all fungal infections), Aspergillus (about 16%), and Cryptococcus (about 16%).

Coccidioidomycosis (“Valley Fever”) may also be a fairly common cause of invasive fungal infections in liver transplant patients living in endemic areas. Coccidioides is a fungi found in dust and soil in desert areas such as southern California, Arizona, New Mexico, and northern Mexico. Activities that disrupt soil, such as construction, excavation, gardening, or archeological digs can significantly increase airborne levels of Coccidioides fungi.

Coccidioides fungi also pose a menace to live transplant patients, especially to those not receiving prophylactic anti-fungal drugs. A Phoenix, AZ hospital reported that 10 out 349 (2.9%) liver transplant patients not receiving prophylactic anti-fungal drugs developed invasive Coccidioidomycosis. Among a second group of liver transplant patients who received prophylactic treatment with the anti-fungal drug fluconazole, 0 of 143 patients developed invasive Coccidioidomycosis.

 

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