P1665 - Insights Into Fungal Infections in Liver Transplant Recipients: A Nationwide Inpatient Sample Analysis

Yasmin O. Ali, MBBS¹, Christopher Behrend, MD¹, Fatima Elmustafa, MBBS², Spencer Goble, MD³
1Hennepin Healthcare, Minneapolis, MN; 2Henry Ford Warren, Warren, MI; 3University of Minnesota, Minneapolis, MN

Introduction: Liver transplant (LT) recipients are particularly vulnerable to fungal infections due to
immunosuppression, which significantly impacts survival. While studies exist, nationwide
assessments of fungal infection patterns and outcomes in this population are lacking. This study
aims to provide a comprehensive overview of fungal infections in liver transplant
hospitalizations.

Methods: We utilized the National Inpatient Sample (NIS) from 2016 to 2021 to identify adult liver
transplant recipients with fungal infections using ICD-10 codes. Patient outcomes were
compared between hospitalizations with and without fungal infections. Primary outcomes
included mechanical ventilation, extracorporeal membrane oxygenation (ECMO), sepsis, renal
replacement therapy (RRT), and inpatient mortality. Healthcare utilization, including length of
stay (LOS) and costs, was also assessed. Multivariate logistic regression models were used to
adjust for potential confounding variables.

Results: Among 45,460 hospitalizations of liver transplant (LT) recipients, fungal infections accounted for
4% (1,850), with Candida (2.3%), Cryptococcus (0.1%), Aspergillus (0.6%), and
Coccidioidomycosis (0.9%). Fungal infections predominantly affected White patients (63.1%,
p<0.001), with a mean age of 63.1 years, and were most prevalent in the western region (37.6%
vs. 19.9%, p<0.001). Compared to the cohort group, Candida infections were associated with
higher mortality (6.1% vs. 2.9%, aOR 1.83), longer hospital stays (48.2 vs. 19.8 days, aRR 2.28,
p<0.001), and higher costs ($298,897 vs. $153,630, aRR 1.75, p<0.001). Aspergillus infections
were associated with increased ECMO use (5% vs. 1.4%, aOR 3.13) and mechanical ventilation
(23.7% vs. 12.8%, aOR 1.74). Cryptococcus infections showed the highest mortality among
fungal infections (13.9% vs. 2.8%, aOR 5.61), sepsis rate (37% vs. 8.1%, aOR 4.34), and increased
ECMO use (5.8% vs. 1.4%, aOR 4.30), all p<0.001. Although Coccidioidomycosis is rare, it was
associated with increased costs ($228,519 vs. $156,500, aRR 0.64, p=0.004) and similar
mortality to Candida infections (6.6% vs. 2.9%, aOR 2.96).

Discussion: Fungal infections in liver transplant recipients are correlated with poorer clinical outcomes,
particularly in the case of Cryptococcal infections. Timely detection and targeted management
strategies are essential for improving patient outcomes.

Disclosures:
Yasmin Ali indicated no relevant financial relationships.
Christopher Behrend indicated no relevant financial relationships.
Fatima Elmustafa indicated no relevant financial relationships.
Spencer Goble indicated no relevant financial relationships.

Yasmin O. Ali, MBBS¹, Christopher Behrend, MD¹, Fatima Elmustafa, MBBS², Spencer Goble, MD³. P1665 - Insights Into Fungal Infections in Liver Transplant Recipients: A Nationwide Inpatient Sample Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.