Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-yearold male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.
Key words: Bacteria; Infective endocarditis; Liver transplantationCore tip: A pre-transplant cardiac assessment should include a careful evaluation for underlying valvular pathology. Bacterial endocarditis can however still occur in liver transplant recipients with normal cardiac valves. Gram negative bacteria though rare can be a causative agent for infective endocarditis. High index of suspicion for bacterial endocarditis is essential when investigating transplant recipients for fever of uncertain origin.George S, Varghese J, Chandrasekhar S, Perumalla R, Reddy MS, Jayanthi V, Rela M. Gram-negative bacteria causing infective endocarditis: Rare cardiac complication after liver transplantation. World J Hepatol 2013; 5(5): 296-297 Available from: URL:
Background: Prophylaxis with hepatitis B immunoglobulin (HBIG) and nucleoside analogs can prevent hepatitis B virus (HBV) recurrence after liver transplant (LT). Aim: To determine the efficacy and cost of maintaining immunoprophylaxis with HBIG and hyperimmune plasma (HIP) for 6 months after LT. Material & methods: The study included 22 HBV related LT recipients who were on entecavir and either HBIG or HIP for 6 months. Post transplant HBIG or HIP dose and cost incurred towards prophylaxis were noted. The cost of 200 IU of HBIG at the time of study was Rs 8250/-(US Dollars 135) and that of 2000 IU of HIP was Rs 8000/-(USD 130.7). The loading and maintenance costs at end of 6 months were compared between the two groups. Response to HBIG and HIP was assessed by checking for HBsAg reactivity, anti HBs titer response and HBV DNA viral load. Statistical analysis: Median and range, Kruskal Wallis (KW) sign rank Sum Test and Correlation Coefficient (r2) was used for analysis. Results: Thirteen recipients received HBIG and 9 recipients HIP. The anti HBs response to HIP was significantly high compared to HBIG (KW Sign rank Sum test P < 0.05); titers remained high until the study period. Between 8 and 30 days, the titer achieved by both HBIG and HIP was similar (KW Sign rank Sum test not significant). Despite low anti HBs titer of <100 IU/L, none of the recipients on HBIG had HBsAg reactivity while 3 on HIP had transient HBsAg positivity. The total cost with HBIG was 13.9 times the cost of HIP. Conclusion: HIP immunoprophylaxis in combination with entecavir achieves a high anti HBs titer at a significant low cost during anhepatic and loading phase. HBV reactivation rates with HBIG and HIP is low despite low anti HBs titer. ( J CLIN EXP HEPATOL 2014;4:209-213)
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