lower, whereas the incidence of septic complications A retrospective analysis was undertaken to determine was comparable with that in the other groups. The inciif the incidence, timing, and severity of acute and dence of acute rejection in patients who have undergone chronic rejection were influenced by the primary distransplantation for nonviral disease receiving polyease necessitating transplantation. Of the 875 liver clonal human anti-cytomegalovirus (CMV) immunoglobtransplantations performed between 1984 and 1992, 768 ulins was also significantly lower than that of patients were primary transplantations and 107 were retranswho did not receive the immunoglobulins (19% vs. 48% plantations. Among the former, 330 patients that were at 3 months; P Å .01), and this was identical to that of liver transplant recipients for a chronic liver disease patients who have undergone transplantation for viral without cancer in the native liver received an ABO-comdisease receiving polyclonal human anti-HBs immunopatible and cross-match-negative graft and were given a cyclosporine-or tacrolimus-based immunosuppres-globulins (19% at 3 months). These results show that the sion. These included primary biliary cirrhosis (PBC, 66 risk of rejection is unequal among patients, being lower patients), primary sclerosing cholangitis ( or monoclonal antibodies in the early postoperative pe-
Background
Antimicrobial prophylaxis is well‐accepted in the liver transplant (LT) setting. Nevertheless, optimal regimens to prevent bacterial, viral, and fungal infections are not defined.
Objectives
To identify the optimal antimicrobial prophylaxis to prevent post‐LT bacterial, fungal, and cytomegalovirus (CMV) infections, to improve short‐term outcomes, and to provide international expert panel recommendations.
Data sources
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
Methods
Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. PROSPERO ID: CRD42021244976.
Results
Of 1853 studies screened, 34 were included for this review. Bacterial, CMV, and fungal antimicrobial prophylaxis were evaluated separately. Pneumocystis jiroveccii pneumonia (PJP) antimicrobial prophylaxis was analyzed separately from other fungal infections. Overall, eight randomized controlled trials, 21 comparative studies, and five observational noncomparative studies were included.
Conclusions
Antimicrobial prophylaxis is recommended to prevent bacterial, CMV, and fungal infection to improve outcomes after LT.
Universal antibiotic prophylaxis is recommended to prevent postoperative bacterial infections. The choice of antibiotics should be individualized and length of therapy should not exceed 24 hours (Quality of Evidence; Low | Grade of Recommendation; Strong).
Both universal prophylaxis and preemptive therapy are strongly recommended for CMV prevention following LT. The choice of one or the other strategy will depend on individual program resources and experiences, as well as donor and recipient serostatus. (Quality of Evidence; Low | Grade of Recommendation; Strong).
Antifungal prophylaxis is strongly recommended for LT recipients at high risk of developing invasive fungal infections. The drug of choice remains controversial. (Quality of Evidence; High | Grade of Recommendation; Strong).
PJP prophylaxis is strongly recommended. Length of prophylaxis remains controversial. (Quality of Evidence; Very Low | Grade of Recommendation; Strong).
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.