Infectious complications in liver transplantation
J. O. Colonna 2nd, D. J. Winston, J. E. Brill, L. I. Goldstein, M. P. Hoff, J. R. Hiatt, W. Quinones-Baldrich, K. P. Ramming and R. W. Busuttil
Department of Surgery, UCLA-Center for the Health Sciences 90024.
Thirty-five patients received 42 liver homografts between February 1984 and
August 1985. One or more infections developed in 23 patients (66%) some
time after transplantation. An average of 2.5 infections per infected
patient occurred. Of 37 bacterial infections, two thirds were either
bacteremias or localized intra-abdominal infections. The median onset was
29 days after operation. Thirteen viral infections were identified, with a
median onset of 18 days after operation. Nine fungal infections, six
disseminated and three localized, were identified, with a median onset of
nine days after operation. Infection was the primary cause of death in five
(14%) of 35 patients. Fatal infections were evenly distributed among
bacterial (two), fungal (three), and viral (two) pathogens. Despite
advances in surgical techniques and the use of cyclosporine, infection
after orthotopic liver transplantation is a serious problem. Certain
patients can be identified as high risks for infection and require an
aggressive diagnostic workup followed by early institution of antimicrobial
therapy.