Infections in Liver Transplantation

Mohanraj, B. Sharmila; Rangnekar, Amol S.; TimponeJr., Joseph G.

doi:10.1007/978-1-4939-9034-4_3

Cited by 5 publications

(4 citation statements)

References 334 publications

(368 reference statements)

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“…In the setting of liver transplantation, the early postoperative period carries a particularly high risk of infection, because the host had just gone through extensive surgical stress and received high degrees of immunosuppression. During the early post-transplantation period, healthcare-acquired bacterial and fungal infections are the most common types of infection encountered in liver transplant recipients [ 1 ]. Because the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen [ 2 ], the issue of high-dose oxygen therapy for infection in liver transplantation raises interests.…”

Section: Introductionmentioning

confidence: 99%

Oxygen “therapy” for infection in liver transplant surgery: less is more, enough is enough

Sun

2023

BMC Med

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Section: Introductionmentioning

confidence: 99%

Oxygen “therapy” for infection in liver transplant surgery: less is more, enough is enough

Sun

2023

BMC Med

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“…[13][14][15] Even in a regular course after LT, long-term outcomes are often compromised by infectious diseases, either bacterial, viral or fungal, which are mainly attributed to the posttransplant IS burden. [16][17][18] Among these, Cytomegalovirus (CMV) is still one of the most relevant viral pathogens after LT. 19 Before the introduction of CMV prophylaxis, the prevalence of CMV infection after LT was reported to reach 80%. Even in the current modern era of solid organ transplantation, it still remains highly important with prevalence of about 30% and associated increased overall mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Even in a regular course after LT, long‐term outcomes are often compromised by infectious diseases, either bacterial, viral or fungal, which are mainly attributed to the posttransplant IS burden 16–18 . Among these, Cytomegalovirus (CMV) is still one of the most relevant viral pathogens after LT 19 . Before the introduction of CMV prophylaxis, the prevalence of CMV infection after LT was reported to reach 80%.…”

Section: Introductionmentioning

confidence: 99%

Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

Ossami Saidy,

Kollar,

Czigany

et al. 2023

Transplant Infectious Dis

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IntroductionCytomegalovirus (CMV)‐infection and reactivation remain a relevant complication after liver transplantation (LT). The recipient and donor serum CMV‐IgG‐status has been established for risk stratification when choosing various pharmaceutical regimens for CMV‐prophylaxis in the last two decades. However, factors influencing course of CMV‐infection in LT remain largely unknown. In this study, the impact of immunosuppressive regimen was examined in a large cohort of patients.MethodsAll patients that underwent primary LT between 2006 and 2018 at the Charité–Universitaetsmedizin, Berlin, were included. Clinical course as well as histological and laboratory findings of patients were analyzed our prospectively maintained database. Univariate and multivariate regression analysis for impact of variables on CMV‐occurrence was conducted, and survival was examined using Kaplan–Meier analysis.ResultsOverall, 867 patients were included in the final analysis. CMV‐infection was diagnosed in 325 (37.5%) patients after transplantation. Significantly improved overall survival was observed in these patients (Log rank = 0.03). As shown by correlation and regression tree classification and regression tree analysis, the recipient/donor CMV‐IgG‐status with either positivity had the largest influence on CMV‐occurrence. Analysis of immunosuppressive burden did not reveal statistical impact on CMV‐infection, but statistically significant inverse correlation of cumulative tacrolimus trough levels and survival was found (Log rank < .001). Multivariate analysis confirmed these findings (p = .02).DiscussionCMV‐infection remains of clinical importance after LT. Undergone CMV‐infection of either recipient or donor requires prophylactic treatment. Additionally, we found a highly significant, dosage‐dependent impact of immunosuppression (IS) on long‐term outcomes for these patients, underlying the importance of minimization of IS in liver transplant recipients. image

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“…[ 2 ] Patients with chronic liver disease (CLD), such as cirrhosis, autoimmune hepatitis, hepatobiliary malignancies, and liver transplant recipients are at increased risks of infections, morbidity, and mortality compared to the healthy population. [ 3 4 ] In addition, CLD patients are at increased risk of both acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and developing severe disease, comprising between 2 and 11% of all severe cases. [ 5 ] COVID-19 mortality ranges between 19-51% in patients with cirrhosis and is directly proportional to the advanced Child-Turcotte-Pugh class.…”

Section: Introductionmentioning

confidence: 99%

Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation

Alqahtani

Barry

Memish

et al. 2021

Saudi Journal of Gastroenterology

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Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.

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Infections in Liver Transplantation

Cited by 5 publications

References 334 publications

Oxygen “therapy” for infection in liver transplant surgery: less is more, enough is enough

Oxygen “therapy” for infection in liver transplant surgery: less is more, enough is enough

Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation

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