TY - JOUR
T1 - Invasive pulmonary aspergillosis after liver transplantation
T2 - lessons from successfully treated cases and review of the literature
AU - Abe, Kodai
AU - Shinoda, Masahiro
AU - Uno, Shunsuke
AU - Obara, Hideaki
AU - Kitago, Minoru
AU - Abe, Yuta
AU - Hishida, Tomoyuki
AU - Yagi, Hiroshi
AU - Hasegawa, Yasushi
AU - Kitagawa, Yuko
N1 - Funding Information:
We thank Dr. Katsuhiko Kamei, Professor of Medical Mycology Research Center, Chiba University in Japan, for his help with the identification of some fungal isolates.
Publisher Copyright:
© 2021, Springer Nature Singapore Pte Ltd.
PY - 2021/8
Y1 - 2021/8
N2 - Purpose: Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. Methods: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. Results: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. Conclusions: Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.
AB - Purpose: Invasive pulmonary aspergillosis (IPA) after liver transplantation (LT) is most often fatal. We analyzed the outcomes of IPA in a single center. Methods: We reviewed, retrospectively, the medical records of recipients of living donor LT (LDLT) or deceased donor LT (DDLT) performed between 1995 and 2019 at our institute. We analyzed the incidence of IPA and assessed the treatment courses of patients treated successfully and those not treatment successfully. Results: Among 326 recipients, IPA was diagnosed in 6 (1.8%). The incidence of IPA was significantly higher in patients with acute liver failure (ALF, 9.8%) than in those without ALF (0.4%), after DDLT (8.8%) than after LDLT (1.0%), and in recipients who received preoperative steroid pulse therapy (16.0%) than in those who did not (0.7%). Complete cure of IPA was achieved in the most recent three patients, by administering voriconazole immediately after the diagnosis of IPA and performing lung resection, while the IPA lesion was single and localized. Conclusions: Patients with risk factors for IPA must be monitored closely. Our three successfully treated cases demonstrate that initiating immediate voriconazole treatment and making a calculated decision about lung resection can contribute to a favorable outcome.
KW - Invasive pulmonary aspergillosis
KW - Liver transplantation
KW - Lung resection
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U2 - 10.1007/s00595-021-02263-z
DO - 10.1007/s00595-021-02263-z
M3 - Article
C2 - 33738584
AN - SCOPUS:85102653929
SN - 0941-1291
VL - 51
SP - 1361
EP - 1370
JO - Surgery today
JF - Surgery today
IS - 8
ER -