Infections in liver transplantation: risk factors and strategies for prevention

Infection affects up to 70% of liver transplant recipients and is the second most common complication after rejection and graft dysfunction. Identified risk factors for infection include: previous transplantation; type of biliary anastomosis; transfusion requirements at surgery; surgical complications; duration of operation; duration of postoperative ventilation; serological status of donor and recipient; steroid use and serotherapy for rejection; and pre- and post-transplant antibiotic usage. The majority of symptomatic infections are bacterial and relate to surgery (intra-abdominal, biliary and wound infections), ventilation and intravenous cannulae. Cytomegalovirus infections occur in 45-100% of recipients but are asymptomatic in the majority. Fungal infections are mostly due to Candida albicans but infections due to Aspergillus spp. occur in approximately 6% and carry a high mortality. There are very few prospective comparative trials of antimicrobial prophylaxis in this patient population. The management of these patients needs to be based on such studies.