原位肝移植术后真菌感染43例次诊治体会

Fungal infection following orthotopic liver transplantation: report of 43 cases

目的探讨原位肝移植术后真菌感染的诊断、治疗及预防。方法回顾总结为 175位患者所施行的 180次原位肝移植的临床资料 ,并对可能导致真菌感染的危险因素进行统计学分析。结果全组 2 9例患者出现 4 3例次真菌感染 ,感染率为 16 6 % (2 9/ 175 )。其中念珠菌占 98% (4 2 /4 3) ,曲霉菌 2 % (1/ 4 3)。发病中位时间为术后 2 6d(3～ 96d)。常见感染部位依次是肺部 37% (16 /4 3) ,肠管 19% (8/ 4 3)和血液 16 % (7/ 4 3)。 2 6例患者接受氟康唑治疗 ,感染严重的 8例患者改用脂质体两性霉素B治疗。病死率 4 5 % (13/ 2 9) ,直接与真菌感染有关的病死率为 4 0 % (7/ 175 )。全胃肠外营养时间较长、抗生素治疗超过 3周或出现肝动脉并发症的患者真菌感染的发生率显著增加。结论 真菌感染是影响肝移植生存率的重要原因之一。最常见的感染部位和病原菌分别是肺部和念珠菌。减少各种危险因素将有助于降低真菌感染的发生率。早期诊断和及时治疗是治愈的关键 ,严重的真菌感染应及时给予两性霉素B或其脂质体治疗。

ObjectiveTo improve the diagnosis, treatment and prophylaxis of fungal infections following orthotopic liver transplantation (OLT). Methods Medical records from 175 consecutive patients who underwent 180 OLT at our centre from 1993 and 2002 were retrospectively reviewed for fungal infection. ResultsTwenty nine patients(16 6%) developed invasive fungal infection. Median posttransplantation interval was 26 days (range 3 to 96) and respiratory tract was the most common infectious site (37%). Pathogens were Candida species (24 of 43, 98%) and Aspergillus (1 of 43, 2%). Fungal infections occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use over 3 weeks or hepatic artery complications. After treatment with Fluconazole (26 patients) and liposomal amphotericin B (8 patients with serious fungal infections), 16 patients were cured and 13 patients died. The mortality related to fungal infection was 4 0% (7/175). Conclusion Fungal infections are associated with mortality following OLT. Eliminating the various risk factors will decrease the incidence of fungal infection. Amphotericin B or liposomal amphoterin B are effective for patients with serious fungal infection.