Work

Early invasive aspergillosis after liver transplantation: a matched case–control analysis of clinical features and risk factors in a Chinese cohort

Year: 2026

Type: article

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 intensive care unit and intubation durations were excluded from multivariable regression to eliminate temporal bias. RESULTS: Among 1051 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. CONCLUSION: 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.

Source: International Journal of Infectious Diseases

DOI: 10.1016/j.ijid.2026.109206