Viral, Parasitic, Bacterial, and Fungal Infections - Chapter 8: Infections in liver transplantation

Orthotopic liver transplant (LT) represents an important treatment strategy for end-stage liver disease. While transplant recipient survival has improved dramatically, greater than two-thirds of LT patients suffer from infectious complications within the first year after transplant. LT patients are at risk for infections originating from donor organs, surgical complications, hospital and community exposures, and from their own latent infections. A patient’s risk for infection by specific pathogens is related to their net state of immunosuppression—the collective effect of all patient, medication, and disease-related factors on the immune system’s ability to combat infection. Temporal variations in immunosuppression and pathogen exposure produce predictable trends in infection type. Early infections are most often related to surgical complications or latent infection. Opportunistic infections become prevalent during the intermediate phase, against which microbial prophylaxis regimens are utilized. The late phase is characterized by a return to a community-acquired infection profile, although patients with graft dysfunction/rejection episodes remain at risk for opportunistic infections. The understanding of these factors is critical for effective diagnosis and management of infection in post-LT patients.