Surveillance and treatment of liver transplant recipients for candidiasis and aspergillosis

M. A. Viviani, A. M. Tortorano, C. Malaspina, M. Colledan, G. Paone, G. Rossi, G. Bordone, A. Pagano

Research output: Contribution to journalArticlepeer-review

Abstract

Between June 1988 and May 1991 88 orthotopic liver transplants and 1 liver and pancreas transplant were performed at the Liver Transplantation Department of the Ospedale Maggiore of Milan. All the patients underwent mycological surveillance and received antifungal prophylaxis with oral amphotericin B (6000 mg/day) or oral or intravenous fluconazole (200 mg/day) from the time of their transplant. The incidence of Candida colonization was 67%. Fluconazole was superior to oral amphotericin B in the treatment of C. albicans colonization (99 vs 15), but less effective in the treatment of colonization by other Candida spp. (03 vs 33). Deep-seated candidiasis developed in 5 patients, caused by C. albicans in 4 cases and C. krusei in 1. C. albicans infection resolved rapidly with fluconazole in 2 subjects, with intravenous amphotericin B alone in 1, and with amphotericin B plus flucytosine in the other. On the contrary, C. krusei infection did not respond to treatment with amphotericin B combined with flucytosine. Aspergillosis was diagnosed in 11 patients, of whom 4 died from invasive aspergillosis, despite 15 and 26 days of amphotericin B treatment in 2. In another patient invasive aspergillosis, diagnosed a few hours before retransplantation, improved with liposomal amphotericin B, but this man died from cytomegalovirus infection one month later. Aspergillosis was eradicated by itraconazole in 4 other patients and by topical amphotericin B in 2 whose infection was localized to surgical wound.

Original languageEnglish
Pages (from-to)433-436
Number of pages4
JournalEuropean Journal of Epidemiology
Volume8
Issue number3
DOIs
Publication statusPublished - May 1992

Keywords

  • Antifungal treatment
  • Liver transplant
  • Opportunistic fungal infections

ASJC Scopus subject areas

  • Epidemiology

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