Factors Associated with Candidemia After Living Donor Liver Transplantation: A Case-Control Study

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dc.contributor.authorDurmus, Mefkure
dc.contributor.authorKarahan, Sena Guzel
dc.contributor.authorAkbulut, Sami
dc.contributor.authorYilmaz, Zeynep Burcin
dc.contributor.authorKarabulut, Ertugrul
dc.date.accessioned2026-04-04T13:31:02Z
dc.date.available2026-04-04T13:31:02Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground: Liver transplant recipients are highly susceptible to invasive fungal infections, particularly candidemia, due to intensive immunosuppressive therapy and postoperative complications. However, few studies have comprehensively examined postoperative antimicrobial and immunosuppressive factors in this context. Aim: This study aimed to identify perioperative and postoperative factors associated with the development of candidemia in living donor liver transplant (LDLT) recipients, with a particular focus on antimicrobial and immunosuppressive regimens during initial hospitalization. Methods: A retrospective case-control analysis was conducted involving 36 LDLT recipients who developed candidemia (candidemia group) and 72 matched controls without candidemia (non-candidemia group) between January 2019 and November 2023. Demographic and clinical variables were compared using univariate and multivariate logistic regression analyses to identify independent associations. A post hoc power analysis demonstrated a high statistical power (97.3%) to detect large effect sizes. Results: Univariate analysis revealed significant associations with prolonged intubation (p < 0.001), bile leaks (p < 0.001), relaparotomy (p < 0.001), chronic renal disease (p = 0.011), hepatocellular carcinoma (p = 0.011), and the use of antimicrobials including meropenem (p = 0.048), linezolid (p = 0.005), tigecycline (p = 0.045), third-generation cephalosporins (p = 0.003), anidulafungin (p < 0.001), fluconazole (p = 0.006), mycophenolate (p = 0.011), and total parenteral nutrition (TPN) (p = 0.049). CMV prophylaxis (p < 0.001) and CMV-PCR positivity (p = 0.015) were also significantly associated with candidemia. Multivariate logistic regression analysis identified prolonged intubation (OR = 1.07; p = 0.019), bile leaks (OR = 10.9; p = 0.002), anidulafungin use (OR = 4.70; p = 0.032), fluconazole use (OR = 35.8; p = 0.005), and absence of CMV prophylaxis (OR = 11.7; p = 0.021) as independent factors associated with increased odds of candidemia. Conclusions: Prolonged intubation, bile leaks, antifungal exposure, and lack of CMV prophylaxis are independently associated with higher odds of candidemia after LDLT. Targeted prophylaxis, prudent antimicrobial stewardship, and timely biliary intervention may reduce fungal morbidity and mortality in post-transplant patients.
dc.identifier.doi10.3390/jcm14238516
dc.identifier.issn2077-0383
dc.identifier.issue23
dc.identifier.orcid0000-0003-0818-2665
dc.identifier.orcid0000-0002-6864-7711
dc.identifier.orcid0000-0002-5433-591X
dc.identifier.orcid0000-0001-9745-4196
dc.identifier.pmid41375819
dc.identifier.scopus2-s2.0-105024574472
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.3390/jcm14238516
dc.identifier.urihttps://hdl.handle.net/11616/108548
dc.identifier.volume14
dc.identifier.wosWOS:001636193600001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherMdpi
dc.relation.ispartofJournal of Clinical Medicine
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectliving donor liver transplantation
dc.subjectcandidemia
dc.subjectbiliary complications
dc.subjectantibacterial agents
dc.subjectantifungal agents
dc.subjectCMV prophylaxis
dc.subjectimmunosuppressive agents
dc.titleFactors Associated with Candidemia After Living Donor Liver Transplantation: A Case-Control Study
dc.typeArticle

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