Early Invasive Aspergillosis after Liver Transplantation: A Matched Case-Control Analysis of Clinical Features and Risk Factors in a Chinese Cohort.
Abstract
Background
Early invasive aspergillosis (IA) is a severe complication of liver transplantation, but data from Chinese recipients remain limited. We evaluated its clinical characteristics, outcomes, and independent predictors.
Methods
We retrospectively studied adult liver transplant recipients at the First Affiliated Hospital of Zhejiang University from August 2018 to March 2023. Patients meeting 2020 EORTC/MSGERC criteria for proven or probable IA within 1 month post-transplant were matched 1:2 to non-IA controls by age, sex, and etiology. Postoperative ICU and intubation durations were excluded from multivariable regression to eliminate temporal bias.
Results
Among 1,051 recipients, 78 developed early IA (7.4% incidence; 3 proven, 75 probable), matched to 156 controls. Aspergillus fumigatus predominated (64.1%), with a median onset of 5 days. IA was associated with reduced 12-month survival (65.4% vs 80.1%, P = 0.014). Higher acute-on-chronic liver failure (ACLF) grade, preoperative corticosteroid exposure, and postoperative 12-hour lactate >5 mmol/L were independent risk factors.
Conclusions
ACLF severity, pretransplant corticosteroids, and early postoperative hyperlactatemia independently correlate with early IA. These hypothesis-generating findings help identify high-risk recipients requiring targeted surveillance.