Infections in liver transplant recipients

Abstract

Liver transplantation is a standard life-saving procedure for the treatment of many end-stage liver diseases. The success of this procedure may be limited by infectious complications. In this article, we review the contemporary state of infectious complications during the post-operative period, with particular emphasis on those that occur most commonly during the first 6 mo after liver transplantation. Bacteria, and less commonly Candida infections, remain the predominant pathogens during the immediate post-operative period, especially during the first month, and infections caused by drug-resistant strains are emerging. Infections caused by cytomegalovirus and Aspergillus sp. present clinically during the "opportunistic" period characterized by intense immunosuppression. As newer potent immunosuppressive therapies with the major aim of reducing allograft rejection are developed, one potential adverse effect is an increase in certain infections. Hence, it is essential for liver transplant centers to have an effective approach to prevention that is based on predicted infection risk, local antimicrobial resistance patterns, and surveillance. A better understanding of the common and most important infectious complications is anticipated to lead to improvements in quality of life and survival of liver transplant recipients.

Infections After Orthotopic Liver Transplantation

“…Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.…”

“…Triazoles (voriconazole is the drug of choice; itraconazole and posaconazole), caspofungin, or amphotericin B can be considered for treatment. 2,69 Cryptococcus Cryptococcus neoformans is the third most common fungal infection after liver transplantation and most common cause of meningitis in transplant recipients. Inhalation of fungal spores (which have been associated with bird defecation) can results in a possible symptomatic pneumonia or asymptomatic infection often with dissemination to other body sites, most commonly the central nervous system.…”

Infections in Liver Transplant Recipients

“…The bloodstream, surgical wounds, and the urinary tract are common sites for primary infection, which may then disseminate. 3 Except for the herpes simplex virus (HSV) and unusual situations like donor-transmitted viral illnesses (eg, owing to West Nile virus and rabies), viral infections are uncommon during the first month after transplant. 6,7 Between 1 and 6 months, activation of latent infections and opportunistic infections may occur after transplant going to the cummulative effect of immunosuppression.…”

“…The known major risk factors for infection after liver transplant can be grouped into 3 periods. 2,3 Before transplant, latent or unrecognized infections can occur in either the donor or the recipient. These include herpes virus group, tuberculosis, hepatitis B and C (HBV, HCV), human immundeficiency virus, rabies, and West Nile virus infections.…”

“…In addition to screening potential liver donors and recipients for infectious causes, there are 3 general approaches for preventing infections in liver transplant patients: vaccination, administration of prophylactic antimicrobials, and preemptive therapy. [2][3][4] Transplant candidates and recipients are at an increased risk of infectious complications of vaccinepreventable diseases. Because the response to many vaccines is diminished in organ failure, transplant candidates should be immunized early in the course of their diseases.…”