Risk Factors of Invasive Fungal Infection in Recipients After Liver Transplantation: A Systematic Review and Meta-Analysis

Clinical characteristics and outcomes of colonization and infection by yeast species in solid organ transplant recipients: Molecular identification and antifungal susceptibility patterns of isolates

Fungal infections are serious complications after solid organ transplantation, with high mortality and morbidity. Given the importance of the local epidemiological data and also extensive prophylactic regimens in solid organ transplant (SOT) recipients, this study aimed to investigate the clinical characteristics and resistance patterns of yeast isolates in SOT recipients at a main referral transplant center in Iran. Of the 275 recipients enrolled, 22 (8%) had at least one positive yeast culture at a median of 5 days after transplantation. Bacterial infection and reoperation were significantly associated with colonization or infection caused by yeast species (P = .001). Moreover, mortality and length of ICU/hospital stay were significantly higher in patients with positive yeast cultures (P < .05). The most frequent species isolated was Candida albicans (50%), followed by C. glabrata (22.7%). Of species with definite breakpoints, the fluconazole-resistant rate was 23%. Caspofungin and amphotericin B showed potent activity against all isolates. Regarding the high risk of fungal infections, awareness of local epidemiological trends and resistance patterns can help improve outcomes in SOT recipients.

The predictors of fungal infections after liver transplantation and the influence of fungal infections on outcomes

The primary objective of this study was to assess the incidence, timing, risk factors of fungal infections (FIs) within 3 months after liver transplantation (LT). The secondary objective was to evaluate the impact of FIs on outcomes. Four hundred and ten patients undergoing LT from January 2015 until January 2023 in a tertiary university hospital were included in the present retrospective cohort study to investigate the risk factors of FIs and to assess the impacts of FIs on the prognosis of LT recipients using logistic regression. The incidence of FIs was 12.4% (51/410), and median time from LT to the onset of FIs was 3 days. By univariate analysis, advanced recipient age, prolonged hospital stay prior to LT, high Model for End Stage Liver Disease (MELD) score, use of broad-spectrum antibiotics, and elevated white blood cell (WBC) count, increased operating time, massive blood loss and red blood cell transfusion, elevated alanine aminotransferase on day 1 and creatinine on day 3 after LT, prolonged duration of urethral catheter, prophylactic antifungal therapy, the need for mechanical ventilation and renal replacement therapy were identified as factors of increased post-LT FIs risk. Multivariate logistic regression analysis identified that recipient age ≥ 55 years[OR = 2.669, 95%CI: 1.292-5.513, P = 0.008], MELD score at LT ≥ 22[OR = 2.747, 95%CI: 1.274-5.922, P = 0.010], pre-LT WBC count ≥ 10 × 109/L[OR = 2.522, 95%CI: 1.117-5.692, P = 0.026], intraoperative blood loss ≥ 3000 ml [OR = 2.691, 95%CI: 1.262-5.738, P = 0.010], post-LT duration of urethral catheter > 4 d [OR = 3.202, 95%CI: 1.553-6.602, P = 0.002], and post-LT renal replacement therapy [OR = 5.768, 95%CI: 1.822-18.263, P = 0.003] were independently associated with the development of post-LT FIs. Post-LT prophylactic antifungal therapy ≥ 3 days was associated with a lower risk of the development of FIs [OR = 0.157, 95%CI: 0.073-0.340, P < 0.001]. As for clinical outcomes, FIs had a negative impact on intensive care unit (ICU) length of stay ≥ 7 days than those without FIs [OR = 3.027, 95% CI: 1.558-5.878, P = 0.001] but had no impact on hospital length of stay and 1-month all-cause mortality after LT. FIs are frequent complications after LT and the interval between the onset of FIs and LT was short. Risk factors for post-LT FIs included high MELD score at LT, advanced recipient age, pre-LT WBC count, massive intraoperative blood loss, prolonged post-LT duration of urethral catheter, and the need for post-LT renal replacement therapy. However, post-LT prophylactic antifungal therapy was independently associated with the reduction in the risk of FIs. FIs had a significant negative impact on ICU length of stay.

Urban greenery for air pollution control: a meta-analysis of current practice, progress, and challenges

Most governmental initiatives in India, to leash down urban air pollution, have yielded little results till date, largely due to purely technocratic vision, which is shrouded by technological, economic, social, institutional, and political hardships. We present this reflective article on urban greenery, as a proposition to urban authorities (e.g., pollution regulators, environmental systems' managers, urban landscape planners, environmental policy makers), shift from purely technocratic way of thinking to thinking with nature, by strategic greening of urban spaces, for long-term air pollution prevention and control measures. To that end, we offer a meta-analysis of recent (post 2005) global literature using four-stage PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach. We open the narrative by briefing about main pollutant filtration mechanisms by trees, followed by cognitive aspects of species selection (e.g., deciduous vs. evergreen, air pollution tolerance index, environmental stressors). Till date, most Indian studies on urban greenery mostly but focused on physiological aspects of trees. Here, we draw attention of urban authorities to an equally compelling, but yet less explored, aspect: design criteria, with reference to two most common urban configurations, namely, street canyon and open road. With pictorial depictions, we enumerate various categories of street canyons and discuss aspect ratio (building height to street width) and various wind flow regimes (isolated roughness, wake interface, and skimming), that the urban authorities should be cognizant about to maximize pollutant removal efficiency. For open road, we discuss vegetation barriers, with special emphasis on canopy porosity/density functions. In the final sections, we reflect on a potential systems' thinking approach for on-ground implementation, comprising of revamping of urban forestry programs, research and development, community mobilization and stakeholder engagement, and strategic outreach. In addition, we emphasize on means to harness co-benefits of urban greenery, beyond mere pollutant removal, to garner support from urban residents' communities. Last but not the least, we also caution the urban authorities about the undesirable outcomes of urban greenery that will require more process-level research.