Pneumonia after liver transplantation

Abstract

The etiologic patterns, risk factors, and preventive measures for postliver transplantation pneumonia must be understood to minimize patient exposure to modifiable risks and optimize recipient status in the perioperative period. Prevention is multifaceted and may be enhanced by personalization of immune therapy based on predisposition to infection and graft rejection.

A Targeted Swallow Screen for the Detection of Postoperative Dysphagia in Liver Transplant Patients

“…In liver transplant patients, our screen yielded a sensitivity of 90% among the 32 patients who received both a swallow screen and an FEES and a specificity of 83%. Moreover, none of the patients who passed our screen developed aspiration pneumonia during their hospital stay, which is in contrast to the reported 8% to 23% incidence after liver transplant in the study by Angarita et al 24 Although this result may be influenced by our small sample size, our swallowing screen may have reduced the incidence of aspiration pneumonia in our cohort by alerting clinicians about the possibility of dysphagia early after extubation prior to initiation of oral intake. An aim of the present study was to evaluate the validity of this test and compare it to the results obtained by FEES.…”

Controversies in Perioperative Antimicrobial Prophylaxis

“…8 Most opportunistic infections occur several weeks after the initiation of immunosuppression rather than in the immediate posttransplantation period. 52 Thus, the recommended antimicrobial prophylaxis regimen for heart, lung, heart-lung, kidney, and pancreas transplantation procedures is a single dose of cefazolin. 8,51 Note that there is significant controversy regarding the duration of antibiotic prophylaxis, with many centers providing 48 to 72 h despite no evidence of improved outcomes and the potential for increased selection of resistant organisms.…”

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“…The community acquired infections e.g. viruses and food borne gastroenteritis are most common [113]. Occasionally, some recipients will develop primary or late CMV infection, papillomavirus and relapsing viral infections HBV, HCV and HIV [39,114].…”

“…Recurrent cholangitis is one of late infectious complication in fewer number of LTR particularly those who develop biliary complications [112]. Community-acquired pneumonia (CAP) occurs in significant proportion of patients late after LT [113]. The main agents causing CAP are viruses (influenza, RSV) and bacterial pathogens are less common (Streptococcus pneumoniae, Haemophilus influenza and the atypical pathogens such as Mycoplasma pneumoniae and Chlamydia pneumoniae).…”