Invasive mycosis in liver transplantation

Abstract

Liver transplantation is one of the transplant fields where invasive mycosis is frequently encountered. The diagnosis of fungal infection in this population is often very difficult due to the fact that the liver itself is a key organ for immune defence for infection and due to immunosuppressive state of the patient. Although the majority of fungal infection is caused by Candida, Aspergillus infection is gradually increasing and mortality following invasive infection, often multifactorial, reaches to 70%. A characteristic feature of the infection in liver transplant recipients is the high incidence of preceding occult infection, often from the pretransplant period. Although the specificity is not satisfactory, peritransplant screening culture for fungi is a good prognostic parameter. Plasma beta-D-glucan is also very useful in the decision for preemptive treatment, although its plasma level is potentially affected by the reticuloendothelial system of the grafted liver. Referring to these parameters, avoidance of excessive antibiotics and/or immunosuppressants, maintenance of graft function, and a high index of suspicion are always necessary.