Influenza A in the Perioperative Setting of Liver Transplantation

Influenza A infection is associated with significant morbidity in solid organ transplant recipients, particularly in immunosuppressed patients. In liver transplant candidates, diagnosis of respiratory viral infections remains challenging, especially in urgent settings where preoperative screening may have limited sensitivity. We report the case of a 30-year-old woman with unresectable liver metastases from a neuroendocrine tumor who underwent liver transplantation despite mild upper respiratory symptoms and negative preoperative nasopharyngeal PCR testing. In the immediate postoperative period, she developed respiratory deterioration, and PCR testing of bronchial secretions was positive for influenza A. Oseltamivir therapy was initiated, together with adjustments in immunosuppressive treatment. The patient demonstrated rapid clinical improvement, was extubated on postoperative day 1, and was discharged on postoperative day 12. A review of previously reported perioperative influenza cases in liver transplantation highlights the rarity of this condition and the variability of clinical presentation, ranging from mild disease to severe respiratory failure. Diagnostic limitations, including false-negative upper respiratory tract testing and discordance between upper and lower respiratory tract samples, may complicate perioperative decision-making. This case highlights the limitations of current preoperative screening strategies and emphasizes the importance of integrating clinical suspicion with laboratory findings in urgent transplant settings. Early antiviral treatment appears critical for favorable outcomes.