The Influence of Invasive Candida Infections on Prognosis and Analysis of Their Risk Factors After Liver Transplantation

Chunjiao Long; Weiting Peng; Jie Zhao; Qiquan Wan

doi:10.1016/j.clinthera.2024.09.012

The Influence of Invasive Candida Infections on Prognosis and Analysis of Their Risk Factors After Liver Transplantation

Clin Ther. 2024 Oct 4:S0149-2918(24)00276-5. doi: 10.1016/j.clinthera.2024.09.012. Online ahead of print.

Authors

Chunjiao Long¹, Weiting Peng², Jie Zhao³, Qiquan Wan⁴

Affiliations

¹ Department of Nephrology, the Third Xiangya Hospital of Central South University, Changsha, China.
² The Second Affiliated Hospital Class, Grade 2019, 8-Year Clinical Medicine Program, Xiangya School of Medicine, Central South University, Changsha, China.
³ Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Department of Transplant Surgery, the Third Xiangya Hospital of Central South University, Changsha, China; Engineering and Technology Research Center for Transplantation Medicine of National Health Commission, the Third Xiangya Hospital of Central South University, Changsha, China. Electronic address: 13548685542@163.com.

PMID: 39368880
DOI: 10.1016/j.clinthera.2024.09.012

Abstract

Purpose: This study aimed to investigate the incidence, timing, risk factors, and impacts of invasive Candida infections (ICIs) within 3 months after liver transplantation (LT) on LT recipients' prognosis.

Methods: Patients undergoing LT from January 2015 to December 2022 in a tertiary university hospital were investigated the incidence, onset, and risk factors of ICIs and the effects of ICIs on the outcome of LT recipients using statistical methods.

Findings: The mean age of involved 389 LT recipients was 47.3 ± 10.5 years, with 322 (82.8%) being men. The incidence of ICIs was 3.3% (13/389), and the median time between LT and onset of ICIs was 5.0 days. The univariate analysis of predictors of ICIs identified that massive blood loss, prolonged duration of central line and urethral catheter, and prophylactic antifungal therapy were related to post-LT ICI risk. Multivariate logistic regression analysis adjusted for men and age identified that intraoperative blood loss ≥5000 mL (odds ratio [OR] = 7.005, 95% CI: 2.084-23.542, P = 0.002) and central line duration >14 days (OR = 5.270, 95% CI: 1.556-17.854, P = 0.008) were independently associated with the development of post-LT ICIs. Post-LT prophylactic antifungal therapy >3 days reduced ICIs (OR = 0.103, 95% CI: 0.021-0.501, P = 0.005). Regarding clinical outcomes, patients with ICIs were more likely to stay in the intensive care unit for 7 days or longer compared with those without ICIs (OR = 6.910, 95% CI: 1.737-27.493, P = 0.006). ICIs had no impact on hospitalization stay and 1-month all-cause mortality after LT.

Implications: ICIs are frequent and occur early after LT. Predictors of post-LT ICIs were massive intraoperative blood loss and prolonged duration of the central line. However, post-LT prophylactic antifungal therapy reduced ICIs. Patients with ICIs stayed longer in the intensive care unit than those without ICIs.

Keywords: Invasive Candida infection; Liver transplantation; Prognosis; Risk factors.