[Special "supportive" therapy (nutrition, control of infection, intensive care) in transplantation medicine]

With the increase in clinical organ transplantation the importance of specific "supportive" therapy in addition to surgical technique and immunosuppression is being recognized more widely. Our own experience is based on 273 orthotopic liver transplants which were performed in 255 adult patients between September 1988 and May 1992 with an one-year survival rate of 91%. With the routine use of selective bowel decontamination (SBD) pre- and postoperatively 63 bacterial or fungal infections occurred in 57 of 230 liver graft recipients during the first 4 postoperative weeks, 4 of these infections with fatal outcome. The incidence of cytomegalovirus (CMV) disease reached 18.6% (39 of 210 patients). The risk of developing CMV disease depended upon the previous serological status of donor and recipient but also showed an increase after anti-rejection therapy with steroids or OKT3. One death due to CMV pneumonitis occurred. The importance of nutritional support, infectious disease control and intensive care therapy for solid organ transplantation is being discussed in general.