Infectious Complications in Liver Transplantation

Colonna, John O.; Winston, Drew J.; Brill, Judith; Goldstein, Leonard I.; Hoff, Marilyn P.; Hiatt, Jonathan R.; Quiñones-Baldrich, William J.; Ramming, Kenneth P.; Busuttil, Ronald W.

doi:10.1001/archsurg.1988.01400270094015

Cited by 187 publications

(100 citation statements)

References 9 publications

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“…4,5,10,11,35 However, the causative organisms were more diverse than those usually observed in unselected ICU patients. 36 Liver recipients accumulate risk factors for colonization or infection by hospital-acquired and potentially resistant pathogens; these factors include a history of previous hospital stays and previous antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[25][26][27][28][29] Our rate of 15.5% among liver recipients agrees with previously reported rates of pneumonia after LT ranging from 5% to 34%. [4][5][6][7][8][9][10]30 Two recent studies showed a rate of pneumonia of 21.1% in liver recipients receiving a 3-day prophylactic regimen of CTX and ampicillin and a rate of 18% in living donor-related recipients receiving selective digestive decontamination. 6,9 Routine, prolonged prophylactic antibiotic treatment and selective digestive decontamination were not administered in our population.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] The incidence of these infections has been shown to vary from 5% to 48%, whereas estimates of the related mortality rate range from 36.6% to 53%. [4][5][6][7][8][9][10][11] Hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia are commonly dichotomized according to the delay of occurrence: early-onset hospital-acquired pneumonia (E-HAP) and early-onset ventilator-associated pneumonia are usually defined as occurring within the first 4 or 6 days of hospitalization, whereas late-onset hospital-acquired pneumonia (L-HAP) and late-onset ventilator-associated pneumonia occur after this timepoint. 12,13 The types of causative pathogens and their susceptibility differ between these 2 categories, and specific empirical antimicrobial therapy guidelines have been implemented according to these distinctions.…”

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confidence: 99%

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Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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Early-onset hospital-acquired pneumonia (E-HAP) is one of the leading causes of sepsis and mortality after liver transplantation (LT). The appropriate antimicrobial therapy is crucially important for surviving sepsis in this context. The aim of this study was to analyze microbiological findings, associated factors, and optimal antibiotic regimens for E-HAP after LT. Patients demonstrating E-HAP in a single-center cohort of 148 LT recipients were prospectively detected. The diagnosis of pneumonia relied on a combination of supportive clinical findings and a positive culture of a lower respiratory tract sample. E-HAP was considered present if pneumonia occurred within 6 days of intensive care unit (ICU) admission after LT. Twenty-three patients (15.5%) developed E-HAP, which were caused by 36 pathogens (61.1% were gram-negative bacilli, and 33.3% were classified as hospital-acquired). For patients who developed E-HAP, the duration of mechanical ventilation and the ICU stay were significantly longer. Despite a trend toward higher mortality at any time in the E-HAP group, there was no significant difference in mortality between patients with E-HAP and patients without E-HAP. Lactatemia, vasopressor requirements, Simplified Acute Physiology Score II (SAPS II) score on ICU admission, and mechanical ventilation lasting more than 48 hours after LT were associated with E-HAP. Combinations of broad-spectrum b-lactams and aminoglycosides were active against more than 91% of the encountered pathogens. However, antibiotic de-escalation was possible in more than one-third of cases after identification of the pathogens. In conclusion, E-HAP after LT is a severe condition that appears to be influenced by physiological derangements induced by the surgery, such as lactatemia, vasopressor requirements, and mechanical ventilation requirements, as well as the postoperative SAPS II score. At the time of treatment initiation, an antimicrobial regimen usually proposed for late-onset pneumonia should be followed. Orthotopic liver transplantation (LT) is a widely accepted treatment for patients with end-stage liver disease. Despite global improvements in survival over the last few decades, sepsis remains the leading cause of early postoperative mortality. 1,2 Lower respiratory tract infections are a major concern in this context.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Weiss¹,

Dahmani²,

Bert³

et al. 2010

Liver Transpl

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“…First, the minimal nephrotoxicity observed when cyclosporine or tacrolimus is delayed in introduction may be an ameliorating factor because the increased predilection to infection of patients with renal insufficiency is well recognized. [17][18][19] Second, our rejection rate is low, sparing many patients the extra immunosuppression needed to treat a rejection, and the onset of rejection when it does occur is typically delayed until the second postoperative month. By this time the patient is out of the inpatient setting, and an oral recycle of steroids is adequate therapy in Ͼ85% of patients.…”

Section: Discussionmentioning

confidence: 99%

Infectious complications after OKT3 induction in liver transplantation

1997

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The present study examines the incidence, risk factors, bacteriology, and mortality of infectious episodes and the role of antimicrobial prophylactic regimens after OKT3 induction in liver transplantation. Infections occurring in the first 6 months were evaluated according to the Centers for Disease Control criteria in 102 transplant recipients. Patients were administered OKT3 for 5 to 10 days, beginning intraoperatively, azathioprine, low-dose prednisone, and delayed introduction of cyclosporine. There were 140 major and 30 minor infections for an incidence of 1.7 infections per patient. Twenty-seven patients (26%) had no infectious episodes during the 6 months of followup. Bacterial and fungal infections peaked during the first month posttransplantation, whereas viral infections peaked during the second month. Infection-related mortality was 10%. One-year survival rate of patients who suffered a major infection was less than those who were infection free, but the difference was not statistically significant (79% vs. 89%; P ‫؍‬ .61). There was a significantly higher incidence of enterococcal infections under cefotetan prophylaxis than under ampicillinsulbactam (.375 vs. 11 infections per patient; P ‫؍‬ .0017). There were 14 episodes of cytomegalovirus disease (14%) but no cytomegalovirusrelated mortality or graft loss, and all cases responded to ganciclovir treatment. Bivariate and multivariate analyses identified only retransplantation as a risk factor for infection. In conclusion, OKT3 induction after liver transplantation is associated with a manageable incidence of bacterial, viral, or fungal infections. This is caused by, at least in part, improved anti-infective prophylaxis. Copyright 1997 by the American Association for the Study of Liver Diseases I t has been a central tenet in transplantation that any therapy that decreases the likelihood of acute rejection is likely to be accompanied by a corresponding increase in the likelihood of infection. A prime example of this paradigm has been the use of the monoclonal antibody OKT3 to treat steroid-resistant rejection. Although extraordinarily effective in reversing established rejections, the use of OKT3 in these circumstances has been accompanied by an increase in the prevalence of infections, especially those of viral etiology. 1 In contrast, small, randomized comparative studies of OKT3 as induction immunotherapy vs. cyclosporine therapy have not documented an increase in infections with the use of OKT3 in this setting but have shown immunologic advantages such as a 20%-40% decrease in the incidence of acute rejection. 2-5 A detailed examination of infections in liver transplant recipients receiving OKT3 induction has not been published. Therefore, we reviewed an unselected cohort of 102 patients undergoing primary orthotopic liver transplantation to determine the incidence of bacterial, fungal, and viral infections after OKT3 induction, including type, frequency, and risk factors of infections as well as the impact of antimicrobial prophylaxis on the infe...

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“…Infections cause significant morbidity and mortality, which affect graft survival [2]. The described rate is variable, with most of them being bacterial infections [3,4].…”

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confidence: 99%

Infections After Liver Transplantation: A Retrospective, Single-center Study

Antunes

Teixeira

Fortuna

et al. 2015

Transplantation Proceedings

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Objective. To access the incidence of infectious problems after liver transplantation (LT).Design. A retrospective, single-center study. Materials and Methods. Patients undergoing LT from January 2008 to December 2011 were considered. Exclusion criterion was death occurring in the first 48 hours after LT. We determined the site of infection and the bacterial isolates and collected and compared recipient's variables, graft variables, surgical data, post-LT clinical data. Results. Of the 492 patients who underwent LT and the 463 considered for this study, 190 (Group 1, 41%) developed at least 1 infection, with 298 infections detected. Of these, 189 microorganisms were isolated, 81 (51%) gram-positive bacteria (most frequently Staphylococcus spp). Biliary infections were more frequent (mean time of 160.4 AE 167.7 days after LT); from 3 months after LT, gram-negative bacteria were observed (57%). Patients with infections after LT presented lower aminotransferase levels, but higher requirements in blood transfusions, intraoperative vasopressors, hemodialysis, and hospital stay. Operative and cold ischemia times were similar. Conclusion. We found a 41% incidence of all infections in a 2-year follow-up after LT. Gram-positive bacteria were more frequent isolated; however, negative bacteria were commonly isolated later. Clinical data after LT were more relevant for the development of infections. Donors' variables should be considered in future analyses.

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Infectious Complications in Liver Transplantation

Cited by 187 publications

References 9 publications

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Early-onset pneumonia after liver transplantation: Microbiological findings and therapeutic consequences

Infectious complications after OKT3 induction in liver transplantation

Infections After Liver Transplantation: A Retrospective, Single-center Study

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