背景:感染,包括侵袭性真菌感染(IFIs),是肝移植受者在移植后第一年死亡的主要原因之一。
目的:为了调查流行病学,临床表现,危险因素,治疗结果,肝移植后侵袭性曲霉病(IA)的死亡率。
方法:在本病例对照研究中,通过审查在德黑兰伊玛目霍梅尼医院综合大楼接受肝移植的850名患者的存档和电子病历,确定了22名IA患者。伊朗,2014年至2019年。对照组包括38例年龄和性别相匹配的无IA感染患者。获得的信息包括肝移植患者的基线特征,手术报告,两组的移植后特征以及患者组的真菌感染信息。
结果:ImamKhomeini医院肝移植受者中IA的患病率为2.7%。研究患者中IA的危险因素包括移植前后血清肌酐水平高,肾脏替代疗法,抗胸腺细胞球蛋白诱导疗法,移植后胆漏,移植后肝动脉血栓形成,移植后30天内重复手术,在曲霉病诊断之前的细菌性肺炎,在曲霉菌感染前接受全身抗生素治疗,巨细胞病毒感染,和重症监护病房移植后住院时间。最常见的感染形式是侵袭性肺曲霉病,最常见的胸部计算机断层扫描检查结果是结节,胸腔积液,和光环标志。在案例组中,预防性抗真菌治疗的频率高于对照组.12周抗真菌治疗反应率为63.7%。IA患者的3月和12月死亡率分别为36.4%和45.4%,分别(与对照组12个月的死亡率相比,为零)。
结论:在这项研究中,肝移植受者中IA的患病率相对较低.然而,它是肝移植后死亡的主要原因之一.靶向抗真菌治疗可能是我们机构感染发生率低的一个因素。确定国际金融机构的危险因素,保持较高的临床怀疑水平,早期抗真菌治疗可显著改善肝移植受者的预后,降低病死率。
BACKGROUND: Infections, including invasive fungal infections (IFIs), are among the leading causes of mortality in liver transplant recipients during the first year post-transplantation.
OBJECTIVE: To investigate the epidemiology, clinical manifestations, risk factors, treatment outcomes, and mortality rate of post-liver transplantation invasive aspergillosis (IA).
METHODS: In this case-control study, 22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran, Iran, between 2014 and 2019. The control group comprised 38 patients without IA infection matched for age and sex. The information obtained included the baseline characteristics of liver transplant patients, operative reports, post-transplantation characteristics of both groups and information about the fungal infection of the patient group.
RESULTS: The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%. The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant, renal replacement therapy, antithymocyte globulin induction therapy, post-transplant bile leakage, post-transplant hepatic artery thrombosis, repeated surgery within 30 d after the transplant, bacterial pneumonia before the aspergillosis diagnosis, receiving systemic antibiotics before the aspergillus infection, cytomegalovirus infection, and duration of post-transplant hospitalization in the intensive care unit. The most prevalent form of infection was invasive pulmonary aspergillosis, and the most common chest computed tomography scan findings were nodules, pleural effusion, and the halo sign. In the case group, prophylactic antifungal therapy was administered more frequently than in the control group. The antifungal therapy response rate at 12 wk was 63.7%. The 3- and 12- mo mortality rates of the patients with IA were 36.4% and 45.4%, respectively (compared with the mortality rate of the control group in 12 mo, which was zero).
CONCLUSIONS: In this study, the prevalence of IA among liver transplant recipients was relatively low. However, it was one of the leading causes of mortality following liver transplantation. Targeted antifungal therapy may be a factor in the low incidence of infections at our facility. Identifying the risk factors of IFIs, maintaining an elevated level of clinical suspicion, and initiating early antifungal treatment may significantly improve the prognosis and reduce the mortality rate of liver transplant recipients.