Paranasal Aspergillosis in Patients Prior to Liver Transplantation

Bum Gyoon Kim; Youngnam Roh; Hyunghwan Moon; Tae-Seok Kim; Sanghoon Lee; Sanghyun Song; Milljae Shin; Jong Man Kim; Choon Hyuck David Kwon; Sung Joo Kim; Jae-Won Joh; Suk-Koo Lee

doi:10.4285/jkstn.2011.25.4.245

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Kim, Roh, Moon, Kim, Lee, Song, Shin, Kim, Kwon, Kim, Joh, and Lee: Paranasal Aspergillosis in Patients Prior to Liver Transplantation

Original Article

J Korean Soc Transplant 2011;25(4):245-248.

Published online: 10 January 2011

DOI: https://doi.org/10.4285/jkstn.2011.25.4.245

Paranasal Aspergillosis in Patients Prior to Liver Transplantation

Bum Gyoon Kim, M.D., Youngnam Roh, M.D., Hyunghwan Moon, M.D., Tae-Seok Kim, M.D., Sanghoon Lee, M.D., Sanghyun Song, M.D., Milljae Shin, M.D., Jong Man Kim, M.D., Choon Hyuck David Kwon, M.D., Sung Joo Kim, M.D., Jae-Won Joh, M.D., Suk-Koo Lee, M.D.

¹Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

책임저자：조재원, 서울시 강남구 일원동 50성균관대학교 의과대학 삼성서울병원 외과, 135-710 Tel: 02-3410-3466, Fax: 02-3410-0040 E-mail: jw.joh@samsung.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Aspergillosis infection is associated with high morbidity and mortality in liver transplant recipients. This study investigated the prognosis of liver transplant recipients with a pre-operative treatment for paranasal aspergillosis.

Methods

We collected data from 979 cases of patients who underwent liver transplants at the Samsung Medical Center from May 1996 to Feburary 2010.

Results

Eight patients were diagnosed with paranasal aspergillosis after functional endoscopic sinus surgery (FESS), before liver transplantation. In these 8 patients, 7 (87.5%) were male, with a mean age of 55 years. All patients had a hepatitis B virus infection, and 6 patients had hepatocellular carcinoma. The mean days from FESS to liver transplantation was 31 (range, 12∼47 days) and anti-fungal agents were not used during these periods. All 8 patients were free from a recurrence of aspergillosis after liver transplantation.

Conclusions

Surgical treatment for paranasal aspergillosis in patients prior to liver transplantation does not induce aspergillosis infection after transplantation.

Keywords: Fungal infection, Liver transplantation, Aspergillosis, Functional endoscopic sinus surgery

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Fig. 1.

OMU-CT shows the calcification of left maxillary sinus.

Fig. 2.

Microscopic finding of paranasal aspergilloma shows fungal hyphae (Periodic Acid-Schiff Stain).

Table 1.

Clinical characteristics of recipient with aspergillosis after liver transplantation

ID	Sex/age	Dx	CTP	OP	Prophylaxis	Postop ICU	Months PostLTx	Outcome
1	M/64	HBV, HCC	C	LDLT	Fuconazole	8	74	Alive
2	M/45	HBV, HCC	A	LDLT	Itraconazole	7	64	Alive
3	M/54	HBV, HCC	B	LDLT	Itraconazole	11	53	Alive
4	F/58	HBV	C	LDLT	Itraconazole	8	42	Alive
5	M/53	HBV, HCC	C	LDLT	Itraconazole	9	22	Alive
6	M/55	HBV, HCC	B	LDLT	Itraconazole	3	18	Alive
7	M/61	HBV, HCC	B	LDLT	Itraconazole	4	13	Alive
8	M/52	HBV	C	LDLT	Itraconazole	5	9	Alive

Abbreviations: Dx, diagnosis; CTP, Child-Turchotte-Pugh score; OP, operation; LDLT, living donor liver transplantation; post LTx, post liver transplantation; HCC, hepatocellular carcinoma.

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