Postoperative severe pneumonia in adult liver transplant recipients

Severe pneumonia in adult liver transplantation (OLT) recipients is a dangerous condition with significant morbidity and mortality. To analyze the risk factors for postoperative severe pneumonia in OLT patients, we collected data from 132 consecutive adult patients who underwent OLT between February 1999 and April 2004. According to the American Thoracic Society consensus statement, episodes of severe pneumonia were observed in 24 patients (18.2%). We retrospectively reviewed the etiology diagnosis, treatment, and prognosis of the 24 recipients. Bacteria were responsible for 95.8% of these episodes (23 of 24), fungi for 16.7% (4 of 24) and viruses for 4.4% (1 of 24). Twenty-six percent of the bacterial pneumonias were due to Streptococcus alpha hemolyticus. The mortality rate was 37.5% (9 of 24) for patients with severe pneumonia versus 7.4% (8 of 108, P = .004) for patients without pneumonia. Two cases with hepatorenal syndrome died, and three patients with coinfection by bacteria and fungi died. Acute rejection episodes occurred in 15 patients, four of whom died. Mechanical ventilation and tracheotomy were required in 13 cases (54%). Six who experienced prolonged intubation died. Sputum and pleural fluid cultures helped to establish a diagnosis in 91.7% (22 of 24) of cases. Twenty cases (83%) underwent reduction in the immunosuppressive regimen. Patient age, intraoperative transfusion requirements, extubation time, and hospital stay were fatal predictors of prognoses. We concluded that early detection of the responsible pathogen; timely and specific diagnosis; reduction in the immunosuppressive regimen; appropriate treatment with reliable, effective techniques; and implementation of sensitive culture-based antibiotics was an effective strategy to treat severe adult pneumonia in liver transplantation recipients.