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Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature

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Abstract

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.

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Kodai Abe, Masahiro Shinoda, Hideaki Obara, Minoru Kitago, Yuta Abe, Tomoyuki Hishida, Hiroshi Yagi, Yasushi Hasegawa & Yuko Kitagawa

  2. Digestive Diseases Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan

    Masahiro Shinoda

  3. Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan

    Shunsuke Uno

Authors
  1. Kodai Abe
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  2. Masahiro Shinoda
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  3. Shunsuke Uno
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  4. Hideaki Obara
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Corresponding author

Correspondence to Masahiro Shinoda.

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Conflict of interest

There are some conflicts of interest to declare: Masahiro Shinoda, Eisai Co., Ltd and Taiho pharmaceutical Co., Ltd; Yuko Kitagawa, ONO PHARMACEUTICAL CO., LTD., Bristol-Myers Squibb, Olympus Corporation, AsahiKASEI Co., Ltd., TAIHO PHARMACEUTICAL CO., LTD., CHUGAI PHARMACEUTICAL CO., LTD., Otsuka Pharmaceutical Co., Ltd., TSUMURA & CO., Takeda Pharmaceutical Co., Ltd., MEDICON INC., Yakult Honsha Co., Ltd., EA Pharma Co. Ltd., Eisai Co. Ltd.

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Abe, K., Shinoda, M., Uno, S. et al. Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature. Surg Today 51, 1361–1370 (2021). https://doi.org/10.1007/s00595-021-02263-z

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  • DOI: https://doi.org/10.1007/s00595-021-02263-z

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