Infectious Ocular Complications in Orthotopic Liver Transplant Patients

Abstract

We report the frequency and type of infectious ocular complications following orthotopic liver transplantation (OLT) and review diagnostic and therapeutic strategies. During the period September 1988 through November 1994, 684 patients underwent OLT at Mount Sinai Hospital (New York). Nine orthotopic liver transplant patients (1.3%) developed ocular infections: Candida albicans endophthalmitis (2), Aspergillus fumigatus endophthalmitis (1), cytomegalovirus retinitis (4), herpes simplex virus keratitis (1), and varicella-zoster virus panophthalmitis (1). The mean time from OLT to ocular symptoms was 42 days for patients with fungal infections and 128 days for patients with viral infections. Blurred vision was the commonest symptom (five of nine cases). The mean duration of follow-up was 2 years (range, 33 days to 5 years). Permanent loss of vision occurred in three patients, five had improvement in visual acuity, and one died of disseminated aspergillosis 33 days after OLT. Infectious ocular complications following OLT may occur as isolated events or with disseminated disease. Fungal infections occur earlier (mean, 42 days after OLT) than viral infections (mean, 4 months after OLT). The clinical presentation may be atypical; aggressive vitreoretinal procedures and serial examinations may be required to establish the diagnosis. Cytomegalovirus retinitis in orthotopic liver transplant patients may not require life-long maintenance therapy with antiviral agents.

Lack of Reactivation of Cytomegalovirus (CMV) Retinitis after Stopping CMV Maintenance Therapy in AIDS Patients with Sustained Elevations in CD4 T Cells in Response to Highly Active Antiretroviral Therapy

“…It has previously been shown that in iatrogeniThis threshold may be unchanged for new disease, since the incidence of CMV has decreased in patients responding to cally immunosuppressed transplant patients, immune recovery can be accomplished by decreasing the dose of immunosuppotent antiretroviral combinations. For established CMV retinitis, we have observed at both institutions unusually long periods pressive medications [22]. The lack of reactivation without specific anti-CMV maintenance in all 11 patients at two sepaof retinitis inactivity, even in patients treated with oral ganciclovir and who experienced more modest rises in CD4 cell rate institutions, during a median observation of 156 days, supports the hypothesis that AIDS patients responding to counts (between 45 and 60/mm 3 ), suggesting that a modification of the history of treated disease may have occurred.…”

Opportunistic Infections in Patients with and Patients without Acquired Immunodeficiency Syndrome

“…A large series from New York City found CMV retinitis in 4 of 684 liver transplant recipients [91]. Symptoms began, on average, 4 months after transplantation.…”

Ocular Complications after Organ and Bone Marrow Transplantation in Children

“…4,10 Ocular infection after renal, cardiac, or bone marrow transplantation is reported between 1.3-5%. 6,[11][12][13] Elevated intraocular pressure is rarely observed, occurring in 1-2% of patients with prolonged oral steroid therapy after transplantation. 5,6,14 Similar data, however, are poorly documented in the pediatric age group.…”