INVASIVE FUNGAL INFECTIONS AFTER ADULT SMALL BOWEL TRANSPLANTATION: RISK FACTORS AND EFFICACY OF PROPHYLACTIC THERAPY

Abstract

P831 Aims: Intestinal transplant recipients are at high risk for invasive fungal infections because of the breach of intestinal mucosa rich in fungal flora due to preservation injury and/or rejection and the chronic need for a relatively heavy post-transplant immunosuppression. Methods: Using a computerized database, we reviewed the medical records of all adult small bowel recipients that were transplanted between May 1990 and February 2002. Invasive fungal infection was defined as positive fungal blood, tissue and deep wound cultures and/or histopathologic fungal identification on tissue samples or autopsy materials. Relevant clinical data including pre-transplant TPN duration, CMV infection, hemodialysis and use of antifungal prophylaxis were gathered and correlated with the presence or absence of invasive fungal infection using Fisher’s exact test. Results: Fifty-nine episodes of invasive fungal infections were identified in 43 (44.8%) out of 96 intestinal recipients. Of these, 47 (80%) were candidiasis, 6 (10 %) were aspergillosis, 3(5%) were dematiaceous fungi, 1 (1.7%) was cryptococcosis, 1 (1.7%) was coccidiomycosis and 2 (3%) were infections by other fungi. CMV disease and hemodialysis were associated with increased risk of invasive fungal infection with a p value of 0.05 and 0.06, respectively. The use of high-dose prophylactic liposomal amphotericin B was protective against function infection, compared to no prophylaxis (p=0.003), and conventional low dose amphotericin B (p=0.014). Age, operative time, ICU stay, use of anti-lymphocyte antibodies, and duration of TPN prior to transplant were not significant risk factors. Conclusions: Invasive fungal infections are common among small bowel transplant recipients. However, the recent use of a high-dose liposomal amphotericin B has been effective as a prophylactic therapy with significant reduction in the incidence of such a serious morbidity and it’s associated mortality.