Invasive fungal infection in liver transplant recipients in a prophylactic era: A multicenter retrospective cohort study in Korea

Youn Jeong Kim, Sang Il Kim, Jong Young Choi, Seung Kew Yoon, Gun Hyung Na, Young Kyoung You, Dong Goo Kim, Myoung Soo Kim, Jae Geun Lee, Dong Jin Joo, Soon Il Kim, Yu Seun Kim, Sang Oh Lee, Shin Hwang, Eungeol Sim

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Abstract

The epidemiology of invasive fungal infections (IFIs) after liver transplantation (LT) is continuing to evolve in the current era of antifungal prophylactic therapy. This multicenter retrospective cohort study aimed to evaluate the epidemiology, risk factors, and outcomes of IFIs among LT recipients in the current era.We analyzed a total of 482 LT recipients aged 18 years and older who were admitted to 3 tertiary hospitals in Korea between January 2009 and February 2012.Twenty-four episodes of IFIs occurred in 23 patients (4.77%; 23/482). Of these episodes, 20 were proven cases and 4 were probable cases according to EORTC/MSG criteria. Among these cases, IFI developed within 30 days of transplantation in 47.8% of recipients, from 31 to 180 days in 34.8% of recipients, and from 181 to 365 days in 17.4% of recipients. The most common isolates were Candida species (n = 12, 52.2%; Candida albicans, 6 cases; Candida tropicalis, 1 case; Candida glabrata, 1 case; Candida parapsilosis, 1 case; and unspecified Candida species, 1 case) and Aspergillus species (n = 7, 30.4%). The mortality in patients with IFIs was significantly higher than that in patients without IFIs (47.83% [11/23] vs 7.18% [33/459], P < .001). The incidence of late-onset IFIs is increasing in the antifungal prophylactic era, and fluconazole-resistant non-albicans Candida species have not yet emerged in Korea.

Original languageEnglish
Pages (from-to)e16179
JournalMedicine
Volume98
Issue number26
DOIs
Publication statusPublished - 2019 Jun 1

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Korea
Cohort Studies
Retrospective Studies
Liver
Candida
Liver Transplantation
Epidemiology
Candida tropicalis
Candida glabrata
Sodium Glutamate
Fluconazole
Aspergillus
Transplant Recipients
Invasive Fungal Infections
Candida albicans
Tertiary Care Centers
Transplantation
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kim, Youn Jeong ; Kim, Sang Il ; Choi, Jong Young ; Yoon, Seung Kew ; Na, Gun Hyung ; You, Young Kyoung ; Kim, Dong Goo ; Kim, Myoung Soo ; Lee, Jae Geun ; Joo, Dong Jin ; Kim, Soon Il ; Kim, Yu Seun ; Lee, Sang Oh ; Hwang, Shin ; Sim, Eungeol. / Invasive fungal infection in liver transplant recipients in a prophylactic era : A multicenter retrospective cohort study in Korea. In: Medicine. 2019 ; Vol. 98, No. 26. pp. e16179.
@article{2717fb64f9664ee2a6ca07436c69040e,
title = "Invasive fungal infection in liver transplant recipients in a prophylactic era: A multicenter retrospective cohort study in Korea",
abstract = "The epidemiology of invasive fungal infections (IFIs) after liver transplantation (LT) is continuing to evolve in the current era of antifungal prophylactic therapy. This multicenter retrospective cohort study aimed to evaluate the epidemiology, risk factors, and outcomes of IFIs among LT recipients in the current era.We analyzed a total of 482 LT recipients aged 18 years and older who were admitted to 3 tertiary hospitals in Korea between January 2009 and February 2012.Twenty-four episodes of IFIs occurred in 23 patients (4.77{\%}; 23/482). Of these episodes, 20 were proven cases and 4 were probable cases according to EORTC/MSG criteria. Among these cases, IFI developed within 30 days of transplantation in 47.8{\%} of recipients, from 31 to 180 days in 34.8{\%} of recipients, and from 181 to 365 days in 17.4{\%} of recipients. The most common isolates were Candida species (n = 12, 52.2{\%}; Candida albicans, 6 cases; Candida tropicalis, 1 case; Candida glabrata, 1 case; Candida parapsilosis, 1 case; and unspecified Candida species, 1 case) and Aspergillus species (n = 7, 30.4{\%}). The mortality in patients with IFIs was significantly higher than that in patients without IFIs (47.83{\%} [11/23] vs 7.18{\%} [33/459], P < .001). The incidence of late-onset IFIs is increasing in the antifungal prophylactic era, and fluconazole-resistant non-albicans Candida species have not yet emerged in Korea.",
author = "Kim, {Youn Jeong} and Kim, {Sang Il} and Choi, {Jong Young} and Yoon, {Seung Kew} and Na, {Gun Hyung} and You, {Young Kyoung} and Kim, {Dong Goo} and Kim, {Myoung Soo} and Lee, {Jae Geun} and Joo, {Dong Jin} and Kim, {Soon Il} and Kim, {Yu Seun} and Lee, {Sang Oh} and Shin Hwang and Eungeol Sim",
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Kim, YJ, Kim, SI, Choi, JY, Yoon, SK, Na, GH, You, YK, Kim, DG, Kim, MS, Lee, JG, Joo, DJ, Kim, SI, Kim, YS, Lee, SO, Hwang, S & Sim, E 2019, 'Invasive fungal infection in liver transplant recipients in a prophylactic era: A multicenter retrospective cohort study in Korea', Medicine, vol. 98, no. 26, pp. e16179. https://doi.org/10.1097/MD.0000000000016179

Invasive fungal infection in liver transplant recipients in a prophylactic era : A multicenter retrospective cohort study in Korea. / Kim, Youn Jeong; Kim, Sang Il; Choi, Jong Young; Yoon, Seung Kew; Na, Gun Hyung; You, Young Kyoung; Kim, Dong Goo; Kim, Myoung Soo; Lee, Jae Geun; Joo, Dong Jin; Kim, Soon Il; Kim, Yu Seun; Lee, Sang Oh; Hwang, Shin; Sim, Eungeol.

In: Medicine, Vol. 98, No. 26, 01.06.2019, p. e16179.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Invasive fungal infection in liver transplant recipients in a prophylactic era

T2 - A multicenter retrospective cohort study in Korea

AU - Kim, Youn Jeong

AU - Kim, Sang Il

AU - Choi, Jong Young

AU - Yoon, Seung Kew

AU - Na, Gun Hyung

AU - You, Young Kyoung

AU - Kim, Dong Goo

AU - Kim, Myoung Soo

AU - Lee, Jae Geun

AU - Joo, Dong Jin

AU - Kim, Soon Il

AU - Kim, Yu Seun

AU - Lee, Sang Oh

AU - Hwang, Shin

AU - Sim, Eungeol

PY - 2019/6/1

Y1 - 2019/6/1

N2 - The epidemiology of invasive fungal infections (IFIs) after liver transplantation (LT) is continuing to evolve in the current era of antifungal prophylactic therapy. This multicenter retrospective cohort study aimed to evaluate the epidemiology, risk factors, and outcomes of IFIs among LT recipients in the current era.We analyzed a total of 482 LT recipients aged 18 years and older who were admitted to 3 tertiary hospitals in Korea between January 2009 and February 2012.Twenty-four episodes of IFIs occurred in 23 patients (4.77%; 23/482). Of these episodes, 20 were proven cases and 4 were probable cases according to EORTC/MSG criteria. Among these cases, IFI developed within 30 days of transplantation in 47.8% of recipients, from 31 to 180 days in 34.8% of recipients, and from 181 to 365 days in 17.4% of recipients. The most common isolates were Candida species (n = 12, 52.2%; Candida albicans, 6 cases; Candida tropicalis, 1 case; Candida glabrata, 1 case; Candida parapsilosis, 1 case; and unspecified Candida species, 1 case) and Aspergillus species (n = 7, 30.4%). The mortality in patients with IFIs was significantly higher than that in patients without IFIs (47.83% [11/23] vs 7.18% [33/459], P < .001). The incidence of late-onset IFIs is increasing in the antifungal prophylactic era, and fluconazole-resistant non-albicans Candida species have not yet emerged in Korea.

AB - The epidemiology of invasive fungal infections (IFIs) after liver transplantation (LT) is continuing to evolve in the current era of antifungal prophylactic therapy. This multicenter retrospective cohort study aimed to evaluate the epidemiology, risk factors, and outcomes of IFIs among LT recipients in the current era.We analyzed a total of 482 LT recipients aged 18 years and older who were admitted to 3 tertiary hospitals in Korea between January 2009 and February 2012.Twenty-four episodes of IFIs occurred in 23 patients (4.77%; 23/482). Of these episodes, 20 were proven cases and 4 were probable cases according to EORTC/MSG criteria. Among these cases, IFI developed within 30 days of transplantation in 47.8% of recipients, from 31 to 180 days in 34.8% of recipients, and from 181 to 365 days in 17.4% of recipients. The most common isolates were Candida species (n = 12, 52.2%; Candida albicans, 6 cases; Candida tropicalis, 1 case; Candida glabrata, 1 case; Candida parapsilosis, 1 case; and unspecified Candida species, 1 case) and Aspergillus species (n = 7, 30.4%). The mortality in patients with IFIs was significantly higher than that in patients without IFIs (47.83% [11/23] vs 7.18% [33/459], P < .001). The incidence of late-onset IFIs is increasing in the antifungal prophylactic era, and fluconazole-resistant non-albicans Candida species have not yet emerged in Korea.

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