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Infectious complications in liver transplantation

Authors
Nina M Clark, MD
Scott J Cotler, MD
Section Editors
Kieren A Marr, MD
Robert S Brown, Jr, MD, MPH
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

During the past decade, survival rates after liver transplantation have steadily improved, with one-year survival exceeding 85 percent. The improved survival has been attributed to a number of factors including new and more conservative use of immunosuppressive agents, improved diagnostic methods for identifying and preventing infections, and better surgical techniques [1].

The specific factors (preoperative and postoperative) that increase the risk for infection in liver transplant patients will be reviewed here. The most common pathogens responsible for infection at three key time points (the first month after transplant, months 1 through 6, and after the initial six months) will also be discussed. Other issues related to liver transplantation and infections in solid organ transplant recipients are presented separately. (See "Infection in the solid organ transplant recipient" and "Evaluation for infection before solid organ transplantation" and "Prophylaxis of infections in solid organ transplantation".)

EPIDEMIOLOGY

Despite advances in liver transplantation, morbidity and mortality due to infectious complications remain major problems. In many centers, infection is the most frequent cause of death following liver transplantation even though deaths related to infectious diseases in non-transplant settings have steadily decreased. In an autopsy series, for example, infections were the cause of death in 64 percent of 321 transplant patients who died between 1982 and 1997 [2]. The most common types of infection were bacterial (48 percent), fungal (22 percent), and viral (12 percent). In another report, up to two-thirds of all liver transplant patients had at least one episode of infection [3]. Other series have observed infection rates of 1 to 2.5 episodes per patient [4-6]. Infection is the most common cause of fever in liver transplant recipients [7].

GENERAL PRINCIPLES

Several principles of infection in solid organ transplant recipients are important to recognize [8,9]:

Signs and symptoms of infection are often attenuated in the setting of immunosuppression, and infection may be more difficult to diagnose.

                   

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Literature review current through: Nov 2016. | This topic last updated: Tue Aug 23 00:00:00 GMT+00:00 2016.
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