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Published on: November 7, 2020
Epidemiology and Management of Infections in Liver Transplant Recipients
Waseem Amjad1, Syed Hamaad Rahman2, Thomas D Schiano3
1Gastroenterology and Hepatology, University of Maryland, Baltimore, Maryland, USA.
Abstract:
Improvements in liver transplant (LT) outcomes are attributed to advances in surgical techniques, use of potent immunosuppressants, and rigorous pre-LT testing. Despite these improvements, post-LT infections remain the most common complication in this population. Bacteria constitute the most common infectious agents, while fungal and viral infections are also frequently encountered. Multi-drug-resistant bacterial infections develop because of polymicrobial overuse and prolonged hospital stays. Immediate post-LT infections are commonly caused by viruses. Appropriate vaccination, screening of both donor and recipients before LT and antiviral prophylaxis in high-risk individuals are recommended. Antimicrobial drug resistance is common in high-risk LT and associated with poor outcomes; epidemiology and management of these cases is discussed. Additionally, we also discuss the effect of coronavirus disease 2019 (COVID-19) infection and monkeypox in the LT population.
Insights
Liver transplant (LT) recipients face frequent infections, primarily bacterial, posing significant risks. Managing antimicrobial resistance and emerging infectious diseases like COVID-19 is crucial for improving patient outcomes.
Area of Science:
- Hepatology
- Transplant Surgery
- Infectious Diseases
Background:
- Liver transplant (LT) outcomes have improved due to surgical advances and immunosuppression.
- Post-LT infections remain the most frequent complication, impacting patient recovery.
- Bacterial infections are most common, but fungal and viral infections also occur frequently.
Purpose of the Study:
- To review the epidemiology and management of infections in liver transplant recipients.
- To discuss the challenges posed by multi-drug-resistant bacterial infections.
- To address the impact of emerging infectious diseases, including COVID-19 and monkeypox, on LT patients.
Main Methods:
- Literature review of post-liver transplant infections.
- Analysis of bacterial, fungal, and viral infectious agents.
- Discussion of antimicrobial resistance and prophylaxis strategies.
- Inclusion of emerging infectious disease data relevant to LT recipients.
Main Results:
- Bacterial infections are the most prevalent post-LT complication.
- Multi-drug-resistant infections are associated with prolonged hospital stays and poor outcomes.
- Viral infections are common in the immediate post-LT period.
- Emerging infectious diseases like COVID-19 and monkeypox present unique challenges.
Conclusions:
- Despite advances, post-LT infections necessitate vigilant management.
- Antimicrobial stewardship and appropriate prophylaxis are essential.
- Continuous monitoring and adaptation to emerging infectious threats are critical for LT patient care.
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