The potential role for iron overload and fungal infection in liver transplantation

✍ Scribed by David R. Snydman

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 53 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20871

✦ Synopsis

The study published by Alexander et al. in this issue of Liver Transplantation raises a very interesting and provocative hypothesis that the presence of stainable iron in the hepatic explant of patients undergoing liver transplantation was found to be associated with invasive fungal infection. 1 This association could be demonstrated in both univariate and multivariate modeling. The univariate model was consistent with many of the already published risk factors for invasive fungal infection. 2-5 However, the authors readily admit that they did not have access to all the risk factors that have been demonstrated to be associated with invasive fungal infection, such as volume of blood transfused, antibiotic use, development of bacteremia, or colonization with fungal species such as candida. [2][3][4][5] In addition, the authors did not have measures of iron, or transferrin, which might have further elucidated the pathogenesis of invasive fungal infections in these patients. It should also be pointed out that in this group of patients, systemic antifungal prophylaxis was not employed. 6 Despite these limitations, I believe the report is extremely valuable and may point out another risk factor that should be considered from both a surveillance and prevention standpoint, namely iron overload. As the authors note, this association has been demonstrated in bone marrow transplantation. 7,8 To my knowledge this is the first report in liver transplantation, although iron overload and the use of iron chelating agents have long been recognized as risk factors for mucormycosis. 9 Although the role of iron in the pathogenesis of infections has been well documented, the exact role in the clinical setting remains controversial. 10 Iron is an essential component for bacterial virulence in many set-