Post-liver transplantation bacterial infection: current status, prevention and treatment

Liver transplantation (LT) is one of the most effective treatments for end-stage liver disease, as evidenced by a 1-year survival rate of approximately 90% and a 5-year survival rate exceeding 70%. Bacterial infections not only are major complications affecting the quality of life and graft function of LT patients but also constitute the primary causes of morbidity and mortality in this population. Additionally, the rejection response following LT increases the need for postoperative immunosuppressive therapy, and because of the complexity of the immune response in both donors and recipients, LT recipients are more susceptible to bacterial infections than other postoperative patients are. Reports indicate that gram-negative bacteria (such as Enterobacter, Klebsiella, and Pseudomonas) and gram-positive bacteria (such as Staphylococcus and Enterococcus) are common pathogens causing infections after LT. In particular, LT patients are prone to infection with multidrug-resistant (MDR) bacteria, which further complicates infection management. New detection technologies (such as digital droplet PCR, high-resolution melting, surface-enhanced Raman spectroscopy, and cell-mediated immunity) are highly sensitive in the early identification of drug-resistant bacteria and assessment of graft damage. Combining perioperative antibiotic and nonantibiotic therapy can help prevent infections and improve patient prognosis. Currently, effective precautionary warning systems are still lacking internationally, and issues such as dysbiosis caused by broad-spectrum antibiotics and overreliance on traditional methods for infection diagnosis and treatment need to be urgently addressed. This article reviews the relevant literature on the epidemiology and causes of post-LT bacterial infections and new diagnostic and treatment methods to provide a reference for the clinical prediction and prevention of such infections.