MDCT evaluation of early pulmonary infection types after liver transplantation

Area of Science:

• Transplant Surgery
• Infectious Diseases
• Radiology

Background:

• Opportunistic pulmonary infections are a significant cause of morbidity and mortality in liver transplant recipients.
• Early identification and characterization of these infections are crucial for patient outcomes.

Purpose of the Study:

• To determine the incidence, types, and multidetector CT (MDCT) imaging characteristics of pulmonary infections in liver transplant recipients.
• To correlate imaging findings with specific pathogens.

Main Methods:

• Retrospective review of 35 adult liver transplant recipients diagnosed with pulmonary infection within 45 days post-transplantation (March 2002-December 2013).
• MDCT features were analyzed retrospectively by two radiologists.
• Infection diagnoses were confirmed via sputum analysis, cultures, biopsies, and postmortem histopathology.

Main Results:

• Common pathogens included Streptococcus pneumoniae, Candida species, Klebsiella pneumoniae, Aspergillus species, Staphylococcus aureus, Escherichia coli, Mycobacterium tuberculosis, and Acinetobacter species.
• Key MDCT patterns observed were patchy infiltrations (10%), tree-in-bud (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%).
• Tuberculosis presented with a cavitary lesion in one patient.

Conclusions:

• Pulmonary complications post-liver transplant, while not frequent, carry a high mortality risk.
• MDCT is vital for early and accurate diagnosis of pulmonary infections by recognizing specific imaging patterns.
• Vigilance for pulmonary infectious complications in the post-transplant period is essential.