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Infections in human liver recipients: different patterns early and late after transplantation
L Barkholt1, B G Ericzon, J Tollemar
1Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden.
Abstract:
The first 49 consecutive patients who underwent orthotopic liver transplantation between 1984 and 1989 in our department were studied with regard to symptomatic and asymptomatic post-transplantation infections. The major infections carrying a risk of fatal outcome are presented. During the first 4 weeks, fungal and bacterial infections predominated, the percentages of patients affected being 27% and 35%, respectively. Eight patients (17%) suffered from bacterial septicemia, which in six cases was due to gram-negative micro-organisms. The bacterial septicemia was often associated with severe ischemic damage to the graft, rejection, or cholangitis. In addition, a concomitant invasive fungal infection supervened in seven out of eight septic patients, further aggravating the patients' condition. Seventeen of the 49 patients (35%) died after transplantation within 3.3 years. Infection was the cause of death in nine patients (18%), with bacterial septicemia and/or fungemia in eight of these. Cytomegalovirus (CMV) disease was the dominant cause of illness after the 1st month. While only 5 of the 49 patients developed CMV disease during the 1st month (10%), as many as 16 of the 40 recipients who survived beyond that time suffered from symptomatic CMV viremia (40%). CMV mismatching, i.e., the donation of a CMV-positive organ to a CMV-seronegative recipient, entailed the highest risk for CMV disease. Pneumocystis carinii pneumonia occurred within 4 months in 10% of the patients. The four liver recipients affected were among the 20 patients not receiving trimethoprim-sulfamethoxazole prophylaxis. None of the 28 patients who received this prophylaxis over a 12-month period developed this complication (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Post-liver transplant infections are common, with bacterial and fungal infections dominating early on. Cytomegalovirus (CMV) disease and Pneumocystis pneumonia are significant risks, highlighting the need for prophylaxis.
Area of Science:
- Hepatology
- Transplantation Immunology
- Infectious Diseases
Background:
- Liver transplantation is a life-saving procedure, but post-transplant infections pose a significant threat to patient survival.
- Understanding the spectrum and timing of infections is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To analyze the incidence and types of symptomatic and asymptomatic infections in the early and late periods after orthotopic liver transplantation.
- To identify risk factors and causative agents of fatal infections in liver transplant recipients.
Main Methods:
- Retrospective analysis of the first 49 consecutive patients undergoing orthotopic liver transplantation between 1984 and 1989.
- Detailed review of patient records to identify all post-transplantation infections, including bacterial, fungal, viral (CMV), and Pneumocystis pneumonia.
- Correlation of infection types with patient outcomes, including mortality and specific risk factors like CMV mismatching and prophylactic treatment.
Main Results:
- Bacterial and fungal infections predominated within the first 4 weeks (35% and 27%, respectively), with bacterial septicemia occurring in 17% of patients.
- Infections, particularly bacterial septicemia and/or fungemia, were the cause of death in 18% of patients within 3.3 years.
- Cytomegalovirus (CMV) disease became dominant after the first month (40% of survivors), with CMV-positive organ donation to CMV-negative recipients being a major risk factor.
- Pneumocystis carinii pneumonia occurred in 10% of patients, exclusively in those not receiving trimethoprim-sulfamethoxazole prophylaxis (P < 0.005).
Conclusions:
- Early post-liver transplant infections are primarily bacterial and fungal, often associated with graft complications and contributing to mortality.
- Cytomegalovirus (CMV) disease is a major concern in the later post-transplant period, with CMV seromismatching increasing risk.
- Trimethoprim-sulfamethoxazole prophylaxis appears effective in preventing Pneumocystis carinii pneumonia in liver transplant recipients.
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