Medical Mycology: Open Access

Risk Factors and Prevalence for Candidemia in Liver Transplant Recipients without Antifungal Prophylaxis, 10-Year Follow-Up

Objective: Candidemia rates in liver transplant recipients (LTRs) differs from center to center, geographic locations and type of solid organ transplantation. We aimed to investigate the risk factors and prevalence of candidemia in adult LTRs in our center. Methods: Between January 2003 and December 2012, microbiological and clinical data of adult (>18 years) LTRs were searched from mycology laboratory and patients? records retrospectively. The presence of candidemia was defined by determining at least one positive blood culture. Cases were followed at least 150 days after transplantation (150 days-10 years). The risk factors were investigated in preoperative, intraoperative and postoperative periods. None of the patients received antifungal prophylaxis. Result: In the study period, 388 of 472 patients undergoing liver transplantation were included. Candidemia was detected in 10 (2.6%) patients. Among the important risk factors albumin level below 2.8 mg/dl, the use of vascular graft, the presence of biliary complication, hospitalization in intensive care unit(>6days), re-operation, the presence of surgical site infection and postoperative length of stay were detected as significant risk factors. The most common pathogen was C. albicans. Five (50%) patients with candidemia died and C. albicans was responsible for candidemia. Attributable mortality of candidemia was 60%. The presence of candidemia increases the mortality rate significantly (p-value=0.023) Conclusion: Candidemia should be diagnosed as early as possible. In the population without antifungal prophylaxis, candidemia ratio is not higher than the other studies reported formerly. The lower rate of candidemia can be achieved through good patient preparation in pre-transplant period, meticulous surgical technique, use of biological rather than synthetic vascular graft and early discharge after transplantation.

Author(s):

Vildan Avkan-Oguz, Tarkan Unek, Nur Yapar, Esin Firuzan, Mucahit Ozbilgin, Sevda Ozkardesler, Mine Doluca-Dereli, Sedat Karademir

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