Outcome of mucormycosis in liver transplantation: four cases and a review of literature.

Mucormycosis is a rare but highly invasive fungal infection that occurs in transplant recipients. The literature contains descriptions of 12 cases of mucormycosis after orthotopic liver transplantation (OLT). This report describes the fatal courses in four patients at our center who developed mucormycosis after liver transplantation. Of 51 liver transplant recipients who received grafts between December 1993 and April 2003, 4 (7.8%; 3 males and 1 female) developed mucormycosis. The primary liver diseases in the four cases were Wilson's disease, autoimmune hepatitis, primary biliary cirrhosis, and cryptogenic cirrhosis. Three of the transplants were harvested by another team and shipped to our center. We concluded that selection of poor transplant candidates, prolonged antibiotic therapy and/or hospitalization prior to OLT, and breaks in aseptic technique during harvesting, shipping, and during operation are the main reasons for the high incidence of mucormycosis in our OLT patients.