Non- Aspergillus invasive mould infections in liver transplant recipients: A French national retrospective case-control study, 2007–2021

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BACKGROUND: Non-Aspergillus invasive mould infections (IMIs) are emerging in immunocompromised patients, and liver is the second most commonly organ transplanted worldwide. METHODS: We conducted a multicenter retrospective case-control (1:1) study of liver transplant (LT) recipients diagnosed with non-Aspergillus IMIs in France between January 2007 and December 2021. RESULTS: We identified 27/14 332 (0.18%) LT recipients with non-Aspergillus IMIs. Mucorales spp. (48%) were the most common pathogens, followed by Scedosporium spp. (14%), Fusarium spp. (14%), and other IMIs (25%). Lungs were the primary infection site, followed by soft tissues, abdomen, brain, sinuses, heart, and bone. Multivariate analysis showed that a Model for End-stage Liver Disease score > 20 prior to transplantation and primary antifungal prophylaxis (with echinocandins or fluconazole) tended to increase the risk of non-Aspergillus IMIs by nearly threefold ((adjusted Odd Ratio (aOR): 3.73, 95% Confidence Interval (CI) [0.90-15.45], P = .07) and (aOR: 3.93; 95% CI [0.94-16.42], P = .06), respectively). The 6-month mortality rate was 55%. In a Cox survival model, non-Aspergillus IMIs were associated with a threefold increase in mortality risk (Hazard Ratio (HR) : 3.82 [2.01-7.26] P < .001). CONCLUSION: Non-Aspergillus IMIs are rare but highly fatal infections whose early diagnosis in high-risk liver-transplanted patients is essential. Whether or not recently available molecular tools for diagnosing non-Aspergillus IMIs will improve their prognosis in the liver transplantation setting remains to be studied.