Abstract
Invasive fungal infections (IFI) are complications after liver transplantation involving high morbidity and mortality. (1,3)-β-d-glucan (BG) is a biomarker for IFI, but its utility remains uncertain. This study was designed to evaluate the impact of BG following their diagnosis. Between January 2013 and May 2016, 271 liver transplants were performed in our institution. Serum samples were tested for BG (Fungitell®, Associates Cape Code Inc., Falmouth, MA, USA) at least weekly between liver transplantation and the discharge of patients. Nineteen patients (7%) were diagnosed with IFI, including 13 cases of invasive candidiasis (IC), eight cases of invasive pulmonary aspergillosis, and one case of septic arthritis due to Scedosporium apiospernum. Using a single BG sample for the primary analysis of IFI, 95% (21/22) of the subjects had positive BG (>80 pg/mL) at the time of IFI diagnosis. The area under the ROC curves to predict IFI was 0.78 (95% CI: 0.73–0.83). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BG for IFI were 75% (95% CI: 65–83), 65% (62–68), 17% (13–21), and 96% (94–97), respectively. Based on their high NPV, the BG test appears to constitute a good biomarker to rule out a diagnosis of IFI.
Highlights
Patients undergoing liver transplantation (LT) are at risk of developing an invasive fungal infection (IFI) (5–10% of cases) during the early post-operative period (≤2 months) [1,2]
Non-culture-based biomarkers to detect circulating fungal cell wall constituents have been developed during the past twenty years. One such diagnostic assay is (1,3)-β-D-glucan (BG). This fungal wall component is detected in many IFI, including candidiasis, aspergillosis, and Pneumocystis jirovecii pneumonia (PjP), but cannot be used for Cryptococcus and Mucorales infections
In a previous preliminary study, we found that BG could constitute a promising tool to rule out invasive candidiasis in high-risk liver transplant recipients, the optimum diagnostic performance being achieved with a value of 146 pg/mL [14]
Summary
Patients undergoing liver transplantation (LT) are at risk of developing an invasive fungal infection (IFI) (5–10% of cases) during the early post-operative period (≤2 months) [1,2]. The lack of sensitivity and specificity of the diagnostic tests available at present is the principal contributor to a delay in diagnosis. For this reason, non-culture-based biomarkers to detect circulating fungal cell wall constituents have been developed during the past twenty years. Non-culture-based biomarkers to detect circulating fungal cell wall constituents have been developed during the past twenty years One such diagnostic assay is (1,3)-β-D-glucan (BG). This fungal wall component is detected in many IFI, including candidiasis, aspergillosis, and Pneumocystis jirovecii pneumonia (PjP), but cannot be used for Cryptococcus and Mucorales infections. Some of them showed that the detection of BG displayed good sensitivity and specificity for IFI in the general population, even if data are variable according to the population studied [11]
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