Endocarditis in Liver Transplant Recipients: A Systematic Review

Abstract

Infective Endocarditis (IE) is associated with significant mortality. Interestingly, IE in patients with liver transplantation has not been adequately described. The aim of this review was to systematically review all published cases of IE in liver transplant recipients and describe their epidemiology, microbiology, clinical characteristics, treatment and outcomes. A systematic review of PubMed, Scopus and Cochrane Library (through 2nd January 2021) for studies providing epidemiological, clinical, microbiological, treatment data and outcomes of IE in liver transplant recipients was conducted. A total of 39 studies, containing data for 62 patients, were included in the analysis. The most common causative pathogens were gram-positive microorganisms in 69.4%, fungi in 25.8%, and gram-negative microorganisms in 9.7% of cases, while in 9.3% IE was culture-negative. The aortic valve was the most commonly infected valve followed by mitral, tricuspid and the pulmonary valve. Aminoglycosides, vancomycin and aminopenicillins were the most commonly used antimicrobials, and surgical management was performed in half of the cases. Clinical cure was noted in 57.4%, while overall mortality was 43.5%. To conclude, this systematic review thoroughly describes IE in liver transplant recipients and provides information on epidemiology, clinical presentation, treatment and outcomes.

Infective endocarditis in solid organ transplant: a review

“…Studies relying mostly on case reports and case series specifically involving renal and liver organ recipients, often found Enteroccocus spp. to be an equally common or even more common agent of infective endocarditis than S. aureus [15 ▪ ,16,19]. Tamzali et al [8 ▪ ] in their case–control study, also found enterococci as the most common cause of infective endocarditis in renal transplant recipients.…”

“…Symptoms of infective endocarditis at presentation in SOT recipients have been characterized mainly through case reports and case series. Fevers seem to be present in 75–100% of patients, alongside acute kidney injury in 40% and embolic phenomena in 38–46% [16,19]. Infection of the left side of the heart, as in the general population, is most common, with the aortic and mitral valve being involved in similar proportion [6 ▪▪ ,8 ▪ ,15 ▪ ].…”

“…In general, recommendations for choice and duration of antibiotic treatment of infective endocarditis in SOT are the same as for the general population [1]. Reports in the literature confirm that the duration of antibiotic therapy used in practice is similar when comparing infective endocarditis in SOT recipients with their non-SOT counterparts, median of 40–50 days [6 ▪▪ ,15 ▪ ,16,19]. Two reports indicate that there might be lower need for surgical repair in patients with SOT recipients with infective endocarditis as compared with similar patients without transplanted organs [6 ▪▪ ,12 ▪▪ ].…”

“…& ]. Mural endocarditis has been found to be present in around 5-10% of cases [16,19], with one study reporting a higher incidence in this finding amongst SOT recipients with infective endocarditis in comparison to their nontransplant counterparts [6 && ]. Chuang et al [15 & ] found extracardiac complications were more frequent in non-SOT patients with infective endocarditis as opposed to those with SOT and infective endocarditis.…”

Gram-negative endocarditis: disease presentation, diagnosis and treatment

“…GNB-IE represents almost 10% of all episodes of IE in a series of 62 cases of IE in liver transplants [87 ▪ ] and 14.8% of the 117 cases in another study including kidney transplants [88 ▪ ].…”