Invasive Fungal Infections After Liver Transplantation: A Retrospective Matched Controlled Risk Analysis.

BACKGROUND Invasive fungal infections (IFI) are major risks for mortality after liver transplantation (LT). The aim of this study was to evaluate possible risk factors for the development of IFI after LT. MATERIAL AND METHODS All adult patients with IFI after LT between January 2012 and December 2016 at Essen University were identified. Pre-, intra-, and postoperative data were reviewed. These were compared to a 1-to-3 matched control group. Multinominal univariate and multivariate regression analyses were performed. RESULTS Out of the 579 adults who underwent LT, 33 (5.6%) developed postoperative IFI. Fourteen had invasive aspergillosis with 7 (50%) mortality, and 19 had Candida sepsis with 7 (37%) mortality. The overall mortality due to invasive fungal infections was 42%. Perfusion fluid contamination with yeast was detected in 5 patients (15%). Multivariate regression analyses showed that preoperative dialysis (OR=1.163; CI: 1.038-1.302), Eurotransplant donor risk index (OR=0.04; CI=0.003-0.519), length of hospital stay (OR=25.074; CI: 23.99-26.208), and yeast contamination of the preservation fluid (OR=47.8; CI: 4.77-478, 96) were associated with IFI in the Candida group, whereas duration of surgery (OR=1.013; CI: 1.005-1.022), ventilation hours (OR=0.993; CI=0.986-0.999), and days of postoperative dialysis (OR=1.195; CI: 1.048-1,362) were associated with IFI in the aspergillosis group. CONCLUSIONS Post-LT IFI had 42% mortality in our cohort. Prophylactic antifungal therapy should be expanded to broader risk groups as defined above.

Inner Abdominal Fat and Psoas Muscle as Predictive Factors for the Outcome After Liver Transplant.

OBJECTIVES: We analyzed the nutritional condition of liver transplant recipients and the body mass index, the inner abdominal fat tissue, the outer abdominal fat tissue, the psoas muscle size, and the psoas muscle index of the recipients and evaluated the effects of these factors on patient outcomes after liver transplant. MATERIALS AND METHODS: We included recipients of liver transplants from January 2009 to December 2018 who had computed tomography at our center < 3 months before transplant. Preoperative, intraoperative, and postoperative data were evaluated. Outer abdominal fat tissue, inner abdominal fat tissue, and psoas muscle area were measured on the computed tomography abdominal images. We used univariate and multi-variate regression analyses to evaluate the data. RESULTS: There were 265 patients; mean age was 54 years (SD, 13 years). The mean value for body mass index, calculated as weight in kilograms divided by height in meters squared, was 25 (SD, 5). The mean score for Model for End-Stage Liver Disease was 17 (SD, 6). All patients underwent orthotopic liver transplant by standard technique. After adjustment for multivariable analysis, the values for psoas muscle size and the psoas muscle index of the recipient were associated as independent factors for postoperative complications and duration of hospital stay. The survival rate at 1 year was 78.5%, and the rate of perioperative mortality was 16.6%. Independent factors associated with survival after liver transplant were inner abdominal fat tissue, etiology, and rate of major postoperative complications. CONCLUSIONS: Inner abdominal fat tissue, psoas muscle size, and the psoas muscle index are significantly associated with postoperative complications and/or survival after liver transplant. Our results suggest that these prognostic factors may be useful to optimize the selection of appropriate candidates for liver transplant.

Extended ray resection for sarcoma of the hand: long-term survival and functional results.

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan-Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III.