Fungal infections in liver transplant recipients

Sixty-two adults who underwent orthotopic liver transplantations between February 1981 and June 1983 were followed for a mean of 170 days after the operation. Twenty-six patients developed 30 episodes of significant fungal infection. Candida species and Torulopsis glabrata were responsible for 22 episodes and Aspergillus species for 6. Most fungal infections occurred in the first month after transplantation. In the first 8 weeks after transplantation, death occurred in 69% (18/26) of patients with fungal infection but in only 8% (3/36) of patients without fungal infection (P<0.0005). The cause of death, however, was usually multifactorial, and not solely due to the fungal infection. Fungal infections were associated with the following clinical factors: administration of preoperative steroids (P<0.05) and antibiotics (P<0.05), longer transplant operative time (P<0.02), longer posttransplant operative time (P<0.01), duration of antibiotic use after transplant surgery (P<0.001), and the number of steroid boluses administered to control rejection in the first 2 posttransplant months (P<0.01). Patients with primary biliary cirrhosis had fewer fungal infections than patients with other underlying liver diseases (P<0.05). A total of 41% (9/22) of Candida infections resolved, but all Aspergillus infections ended in death.