Résumé
Background: invasive aspergillosis (IA) is a concerning infectious complication after liver transplant (LT). Its incidence ranges between 1.8% and 2%, but its mortality reaches up to 85.7% in previous studies. We aim to describe the epidemiology, the risk factors and the prognosis factors of IA in our LT population. Methods: a nested case-control study was conducted from a retrospective cohort of all adult LT recipients in our institution from 2007 to 2021. Cases were defined as LT recipients with probable or proven IA according to the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Each case was matched with two controls defined as: LT recipients without IA before and after the case chronologically. Results: among 1,001 LT recipients, 2.6% (27/1,001) were diagnosed with IA at a median of 16 [2– 42] days after LT. In comparison to controls, before LT, cases had a higher MELD score (25.5±10.2 vs 20.2±9.8, p=0.03), were more likely hospitalized in the ICU (OR: 4.28 IC%95 [1.44-13.28], p<0.01) and were more likely to suffer from acute on chronic liver failure (OR: 6.54, IC%95 [1.77-27.90], p<0.01). Per-procedure, cases more frequently required red blood cells units transfusion (12.0±9.9 vs 6.5±5.1, p<0.01). Post-LT, cases were more likely to display organ failure (mechanical ventilation (OR: 9.48, IC%95 [2.71-43.24], p<0.01), vasopressors (OR: 6.60, IC%95 [2.16-22.4], p<0.01) or renal replacement therapy (OR: 11.75, IC%95 [3.28-50.13], p<0.01). Surgical reintervention and retransplantation were also associated with IA. At day 90, mortality rate was 40.7% (11/27) in the IA group and 7.4% (4/54) in the control group. Invasive aspergillosis was a predictor of mortality among liver transplant recipients (HR: 5.28, IC%95 [2.12-13.10], p<0.01). Conclusion: in our local cohort of LT recipients, IA was a relatively rare early complication with negative outcome. Patients were more at risk to develop IA depending on pre-, per- and postprocedure parameters. Further studies are needed to better define modalities of a targeted prophylaxis.