这项研究的主要目的是评估发病率,定时,肝移植(LT)后3个月内真菌感染(FIs)的危险因素。次要目标是评估FIs对结果的影响。从2015年1月至2023年1月在一所第三大学医院接受LT的400名患者被纳入本回顾性队列研究,以调查FIs的危险因素,并使用逻辑回归评估FIs对LT受者预后的影响。FIs的发生率为12.4%(51/410),从LT到FIs发作的中位时间为3天。通过单变量分析,接受者年龄较高,在LT之前延长住院时间,终末期肝病(MELD)评分高模型,使用广谱抗生素,白细胞(WBC)计数升高,增加操作时间,大量失血和红细胞输血,LT后第1天丙氨酸转氨酶升高,第3天肌酐升高,延长尿道导管的持续时间,预防性抗真菌治疗,需要机械通气和肾脏替代治疗是LTFIs后风险增加的因素.多因素logistic回归分析确定受者年龄≥55岁[OR=2.669,95CI:1.292-5.513,P=0.008],LT≥22时的MELD评分[OR=2.747,95CI:1.274-5.922,P=0.010],LT前白细胞计数≥10×109/L[OR=2.522,95CI:1.117-5.692,P=0.026],术中出血量≥3000ml[OR=2.691,95CI:1.262-5.738,P=0.010],导尿管术后时间>4d[OR=3.202,95CI:1.553-6.602,P=0.002],和LT后肾脏替代治疗[OR=5.768,95CI:1.822-18.263,P=0.003]与LT后FIs的发展独立相关。LT后预防性抗真菌治疗≥3天与发生FIs的风险较低相关[OR=0.157,95CI:0.073-0.340,P<0.001]。至于临床结果,FIs对重症监护病房(ICU)住院时间≥7天的患者有负面影响[OR=3.027,95%CI:1.558-5.878,P=0.001],但对住院时间没有影响。FIs是LT后的常见并发症,FIs发作与LT之间的间隔很短。LT后FIs的危险因素包括LT时高MELD评分,接受者年龄较高,LT前白细胞计数,术中大量失血,延长尿道导管的LT后持续时间,以及移植后肾脏替代疗法的需要。然而,LT后预防性抗真菌治疗与FIs风险的降低独立相关。FIs对ICU住院时间有显著的负面影响。
The primary objective of this study was to assess the incidence, timing, risk factors of fungal infections (FIs) within 3 months after liver transplantation (LT). The secondary objective was to evaluate the impact of FIs on outcomes. Four hundred and ten patients undergoing LT from January 2015 until January 2023 in a tertiary university hospital were included in the present retrospective cohort study to investigate the risk factors of FIs and to assess the impacts of FIs on the prognosis of LT recipients using logistic regression. The incidence of FIs was 12.4% (51/410), and median time from LT to the onset of FIs was 3 days. By univariate analysis, advanced recipient age, prolonged hospital stay prior to LT, high Model for End Stage Liver Disease (MELD) score, use of broad-spectrum antibiotics, and elevated white blood cell (WBC) count, increased operating time, massive blood loss and red blood cell transfusion, elevated alanine aminotransferase on day 1 and creatinine on day 3 after LT, prolonged duration of urethral catheter, prophylactic antifungal therapy, the need for mechanical ventilation and renal replacement therapy were identified as factors of increased post-LT FIs risk. Multivariate logistic regression analysis identified that recipient age ≥ 55 years[OR = 2.669, 95%CI: 1.292-5.513, P = 0.008], MELD score at LT ≥ 22[OR = 2.747, 95%CI: 1.274-5.922, P = 0.010], pre-LT WBC count ≥ 10 × 109/L[OR = 2.522, 95%CI: 1.117-5.692, P = 0.026], intraoperative blood loss ≥ 3000 ml [OR = 2.691, 95%CI: 1.262-5.738, P = 0.010], post-LT duration of urethral catheter > 4 d [OR = 3.202, 95%CI: 1.553-6.602, P = 0.002], and post-LT renal replacement therapy [OR = 5.768, 95%CI: 1.822-18.263, P = 0.003] were independently associated with the development of post-LT FIs. Post-LT prophylactic antifungal therapy ≥ 3 days was associated with a lower risk of the development of FIs [OR = 0.157, 95%CI: 0.073-0.340, P < 0.001]. As for clinical outcomes, FIs had a negative impact on intensive care unit (ICU) length of stay ≥ 7 days than those without FIs [OR = 3.027, 95% CI: 1.558-5.878, P = 0.001] but had no impact on hospital length of stay and 1-month all-cause mortality after LT. FIs are frequent complications after LT and the interval between the onset of FIs and LT was short. Risk factors for post-LT FIs included high MELD score at LT, advanced recipient age, pre-LT WBC count, massive intraoperative blood loss, prolonged post-LT duration of urethral catheter, and the need for post-LT renal replacement therapy. However, post-LT prophylactic antifungal therapy was independently associated with the reduction in the risk of FIs. FIs had a significant negative impact on ICU length of stay.