Bacterial and fungal infections after liver transplantation: An analysis of 284 patients

✍ Scribed by Jim J. Wade; Nancy Rolando; Karen Hayllar; John Philpott-Howard; Mark W. Casewell; Roger Williams

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 1002 KB
• Volume: 21
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.1840210517

✦ Synopsis

A prospective study of bacterial and fungal infections after liver transplantation in 284 adults was undertaken. One hundred seventy-five (62%) became infected; bacterial or fungal infections occurred in 159 (56%) and 36 (13%) patients, respectively. Gram-positive cocci, in particular Staphylococcus aureus and Enterococcus facium, were the commonest bacterial pathogens, and bacteremia and wound infection were the most frequent bacterial infections. Acute rejection and prolonged admission were independent risk factors for bacterial infection; pretransplantation antibacterials had a protective effect. Fungal infection most frequently involved the urinary tract and chest; Candida a2bicans was the most common pathogen. Four independent variables predicted fungal infection: low pretransplantation hemoglobin, high pretransplantation bilirubin, return to surgery, and prolonged therapy with ciprofloxacin. Patients with acute liver failure were more prone to bacterial, but not fungal, infection. No associations were found between infections and duration of surgery. Bacterial, and to a lesser extent, fungal infections are important complications of liver transplantation. However, liver transplantation surgery per se may not be the major determinant of infection. (HEPATOLOGY 199821: 1328-1336.) During the last decade the number of patients undergoing orthotopic liver transplantation has increased dramatically, and it is now considered an elective, routine procedure for many patients with chronic liver diseasel and an option for selected patients with acute liver failure (ALF).2-4 The 1-and 5-year survival rates in Europe for liver transplantation in the 15to 45year age group are 76% and 65%, re~pectively.~ These encouraging figures are the result of advances in or- gan preservation, immunosuppression, surgical techniques, and better management of complications.',6