Manifestations, Prevalence, Management and Outcome of Invasive Aspergillosis in Post-Liver Transplant Patients

Background: Aspergillosis is a severe and fatal complication that causes infection in transplant recipients and patients with immunodeficiency syndrome, neutropenia, chronic granulomatosis, and hematologic malignancies. Invasive Aspergillosis has been reported as one of the fungal infections with high mortality in transplant recipients. This study aimed to describe the manifestations, prevalence, management and outcome of invasive Aspergillosis fungal infections in liver transplant patients. Methods: This descriptive cross-sectional study was conducted on patients with liver transplantation who were infected with invasive Aspergillosis fungal infections. The data were extracted from the medical records of the archive of Montasryieh Hospital, Mashhad, Iran, between August 2019 and August 2020. Results: In general, 86 patients who had liver transplantation were hospitalized at Montasryieh Hospital from August 2019 to August 2020. Among them, 10 patients were infected with invasive Aspergillosis. Only 6.7% of the patients were categorized under late-onset (> 90 days after liver transplantation), and 93.3% of them were early-onset (< 90 days after liver transplantation). Invasive Aspergillosis fungal infections were suspected based on clinical or radiological signs (possible in 30% of cases; n = 3). The probable diagnosis was reported in 60% (n = 6), and the proven diagnosis was observed only in one patient. In addition, 80% of the patients were diagnosed with Pulmonary Aspergillosis, and two patients had pulmonary Aspergillosis in combination with the central nervous system and cutaneous Aspergillosis. A correlation was found between a comorbid disease and the type of Aspergillosis (r = 0.69; P = 0.02). Voriconazole was effective to treat invasive Aspergillosis in all patients. Conclusion: The prevalence rate of Aspergillosis is relatively high among liver transplant recipient populations (11%). All recipients infected with Aspergillosis had at least one risk factor, including an underlying disease. It seems that Voriconazole therapy is effective among transplant patients with pulmonary Aspergillosis.