New approaches for the detection of invasive fungal diseases in patients following liver transplantation—results of an observational clinical pilot study

• Published in: Langenbeck's archives of surgery 2019-05, Vol.404 (3), p.309-325
• Main Authors: Decker, Sebastian O., Krüger, Albert, Wilk, Henryk, Grumaz, Silke, Vainshtein, Yevhen, Schmitt, Felix C. F., Uhle, Florian, Bruckner, Thomas, Zimmermann, Stefan, Mehrabi, Arianeb, Mieth, Markus, Weiss, Karl Heinz, Weigand, Markus A., Hofer, Stefan, Sohn, Kai, Brenner, Thorsten
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Biomarkers - blood; Cardiac Surgery; DNA, Fungal - blood; Female; General Surgery; Germany; Humans; Intensive Care Units; Invasive Fungal Infections - diagnosis; Invasive Fungal Infections - microbiology; Liver Transplantation; Male; Medicine; Medicine & Public Health; Middle Aged; Opportunistic Infections - diagnosis; Opportunistic Infections - microbiology; Organ Dysfunction Scores; Original Article; Risk Factors; Thoracic Surgery; Traumatic Surgery; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-019-01769-y

Purpose Despite antifungal prophylaxis following liver transplantation (LTX), patients are at risk for the development of subsequent opportunistic infections, such as an invasive fungal disease (IFD). However, culture-based diagnostic procedures are associated with relevant weaknesses. Methods Culture and next-generation sequencing (NGS)-based fungal findings as well as corresponding plasma levels of ß-D-glucan (BDG), galactomannan (GM), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin (IL)-2, -4, -6, -10, -17A and mid-regional proadrenomedullin (MR-proADM) were evaluated in 93 patients at 6 consecutive time points within 28 days following LTX. Results A NGS-based diagnostic approach was shown to be suitable for the early identification of fungal pathogens in patients following LTX. Moreover, MR-proADM and IL-17A in plasma proved suitable for the identification of patients with an IFD. Conclusion Plasma measurements of MR-proADM and IL-17A as well as a NGS-based diagnostic approach were shown to be attractive methodologies to attenuate the weaknesses of routinely used culture-based diagnostic procedures for the determination of an IFD in patients following LTX. However, an additional confirmation within a larger multicenter trial needs to be recommended. Trial registration German Clinical Trials Register: DRKS00005480 .