Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2023; 13(5): 264-275
Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.264
Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality
Azam Farahani, Fereshteh Ghiasvand, Setareh Davoudi, Zahra Ahmadinejad
Azam Farahani, Fereshteh Ghiasvand, Setareh Davoudi, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran 1478714466, Iran
Zahra Ahmadinejad, Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran 1478714466, Iran
Author contributions: Ahmadinejad Z designed the research study, translate the article into English and revised the manuscript according to the reviewer comments; Farahani A performed the research, analyzed the data and prepared the draft of manuscript in Persian language; Ghiasvand F and Davoudi S scientifically and grammatically edit the translated manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional research ethics committee, school of medicine, Tehran university of medical sciences (Approval No. IR.TUMS.MEDICINE.REC.1399.874).
Informed consent statement: Informed consent was waived by the EBR due to retrospective pattern of the study. However the questionnaires were anonymous.
Conflict-of-interest statement: There is no any conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zahra Ahmadinejad, MD, Full Professor, Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, KESHAVARZ Blvd, Dr Gharib Street, Tehran 1478714466, Iran.
Received: June 28, 2023
Peer-review started: June 28, 2023
First decision: August 4, 2023
Revised: August 17, 2023
Accepted: September 4, 2023
Article in press: September 4, 2023
Published online: September 18, 2023
Research background

During the past two decades, the incidence rate and onset time of invasive fungal infections (IFIs), such as aspergillosis, have changed in liver transplant recipients.

Research motivation

Determining the new risk factors and treatment outcomes of early and late-onset invasive aspergillosis (IA) in high-volume centers for liver transplants is essential. It may have a key role in improving the prognosis of these patients.

Research objectives

This study sought to determine the prevalence, risk factors, treatment outcomes, and prognosis of IA infection among liver transplant recipients at our institution. We also investigated the study patients' major clinical, laboratory, and radiologic manifestations of IA.

Research methods

To determine the prevalence of IA, we analyzed the data of 850 patients who received a liver transplant at the Imam Khomeini Hospital Complex in Tehran, Iran, between 2014 and 2019, and recorded the study variables for patients with an IA diagnosis. In addition, we devised a case-control study to identify the risk factors for IA and compare the prognoses of patients with and without IA.

Research results

Our center's IA rate was 2.7%. Pulmonary aspergillosis was the most common presentation of the patients with IA. In most of our patients, imaging findings indicative of aspergillosis, including nodule and halo signs, were detected. The high level of creatinine before and after the transplant, renal replacement therapy after transplantation, induction therapy with antithymocyte globulin, longer duration of intensive care unit admission after the transplant, pneumonia 2 wk before the IA diagnosis, cytomegalovirus viremia within 1 mo before the IA diagnosis, receiving systemic antibiotics for more than three days within the 2 wk before the IA diagnosis, treatment-required transplant rejection within three months before the IA diagnosis, receiving systemic antibiotics for longer than three months before the IA diagnosis, repeated surgery within 30 d after the transplant, biliary leakage after the transplant and hepatic artery thrombosis were the risk factors associated with increased risk of IA.

Research 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. Identifying and addressing risk factors for IA, early diagnosis and prompt treatment of this fatal disease may improve the prognosis and decrease the mortality rate of liver transplant recipients.

Research perspectives

The primary risk factors of IA in liver transplant recipients should be determined through a large, multicenter study. Moreover, we must investigate the role of noninvasive and rapid diagnostic tests in diagnosing patients suspected of IFI early.