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

: 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


Langenbeck's archives of surgery 404 (2019), Nr.3, S.309-325
ISSN: 1435-2443
ISSN: 1435-2451
Fraunhofer IGB ()
Candida spp.; Aspergillus spp.; next-generation sequencing; Interleukin-17A; ß-D-glucan; Mid-regional proadrenomedullin

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.