Deep Candida infection in child liver transplant recipients: serological diagnosis and incidence

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Abstract
Nineteen children who received 22 orthotopic liver grafts on 20 occasions were studied with regard toCandidainfection. Serum samples were analysed to determineCandida,IgA, IgM and IgG antibodies and detect freeC. albicansglucoprotein antigen. Five children (25%) had a confirmed deepC. albicansinfection (DCI) during the first 2 weeks after transplantation. In all children with DCI, serology was positive, a median of 6 days (range 2–9 days) beforeCandidainfection was verified by fungal culture, direct microscopy and/or autopsy. The positive predictive values forCandidaIgG, IgM and IgA antibodies in children with DCI were 100%, 78% and 100%, respectively, and for free C.albicansantigen, 45%. Pathological titres of IgM and IgA antibodies againstCandidabefore liver transplantation were present in three of four children who later developed a DCI and in no child without infection. In conclusion, regular screening byCandidaserology is recommended both before and after liver transplantation.