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Fever in liver transplant recipients: changing spectrum of etiologic agents
F Y Chang1, N Singh, T Gayowski
1Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240, USA.
Abstract:
Febrile episodes in liver transplants were prospectively evaluated. Fever was due to infections in 78% of the episodes (35 of 45) and due to noninfectious causes in 22% (10 of 45). The predominant sources of fever were bacterial infections (62%; 28 of 45) and viral infections (6%; 7 of 45), whereas rejection accounted for only 4% of the episodes (2 of 45). Forty percent of the infections were unaccompanied by fever; fungal infections were significantly less likely to be associated with fever than were viral or bacterial infections (P = .001). Eighty-six percent (6) of the 7 febrile viral infections were due to viruses other than cytomegalovirus, of which human herpesvirus-6 was the predominant pathogen (71%; 5 of 7). Eighty percent (four) of the five febrile episodes with leukopenia were due to human herpesvirus-6. Episodes of fever were most likely to occur within 12 weeks (58%) or 1 year (29%) after transplantation; 100% of the latter episodes were in patients with recurrent hepatitis due to hepatitis C virus, malignancy, or chronic hemodialysis. In conclusion, cytomegalovirus and rejection were no longer the predominant etiologies of fever in liver transplant recipients, and viruses other than cytomegalovirus (e.g., human herpesvirus-6) are emerging as a significant cause of febrile viral illnesses in these patients.
Insights
Fever after liver transplants is often due to infections, primarily bacterial. Emerging viral causes, like human herpesvirus-6, are increasingly significant, while cytomegalovirus and rejection are less common.
Area of Science:
- Hepatology
- Infectious Diseases
- Transplant Medicine
Background:
- Febrile episodes are common in liver transplant recipients.
- Identifying the causes of fever is crucial for patient management.
Purpose of the Study:
- To prospectively evaluate the etiologies of febrile episodes in liver transplant patients.
- To identify the changing patterns of infection and non-infectious causes of fever post-transplant.
Main Methods:
- Prospective evaluation of febrile episodes in liver transplant recipients.
- Categorization of fever causes into infectious and non-infectious origins.
- Analysis of specific pathogens and their association with fever and clinical parameters.
Main Results:
- Infections accounted for 78% of febrile episodes, with bacterial (62%) and viral (6%) infections being predominant.
- Rejection was a less frequent cause (4%).
- Viruses other than cytomegalovirus, particularly human herpesvirus-6, are emerging causes of fever, especially in febrile episodes with leukopenia.
Conclusions:
- Cytomegalovirus and rejection are no longer the primary causes of fever in liver transplant recipients.
- Non-cytomegalovirus viruses, such as human herpesvirus-6, represent a significant emerging cause of febrile illness.
- Fever episodes often occur within the first year post-transplantation, with specific patient groups at higher risk.