Post liver transplant recurrent and de novo viral infections

Abstract

Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy. Post-Liver transplant (LT) de novo or recurrent viral infection continues to cause major allograft dysfunction, leading to poor graft and patient survival in untreated patients. Availability of highly effective antiviral drugs has significantly improved post-LT survival. Patients transplanted for chronic hepatitis B infection should receive life-long nucleos(t)ide analogues, with or without HBIg for effective viral control. Patients with chronic hepatitis C should be commenced on directly acting antiviral (DAA) drugs prior to transplantation. DAA therapy for post-LT recurrent hepatitis C infection is associated with close to 100% sustained virological response (SVR), irrespective of genotype. De novo chronic Hepatitis E infection is an increasingly recognised cause of allograft dysfunction in LT recipients. Untreated chronic HEV infection of the graft may lead to liver fibrosis and allograft failure. Similarly, CMV and EBV can reactivate leading to systemic illness following liver transplantation. With COVID-19 pandemic, post-transplant patients are at risk of SARS-Co-V2 infection. Majority of the LT recipients require hospitalisation, and the mortality in this population is around 20%. Early recognition of allograft dysfunction and identification of viral aetiology is essential in the management of post-LT de novo or recurrent infections. Optimising immunosuppression is an important step in reducing the severity of allograft damage in the treatment of post-transplant viral infections. Viral clearance or control can be achieved by early initiation of high potency antiviral therapy.

Expansion of Double-Negative T Cells in Patients before Liver Transplantation Correlates with Post-Transplant Infections

“…Life-long immunosuppressive therapy has inhibited T cell-mediated alloimmunity, thus leading to a better allograft acceptance. However, the generally compromised T cell immunity in liver transplant recipients also increased the susceptibility to infections in these patients, especially within the first 90 days after LTx [ 3 , 4 , 5 , 6 , 7 ]. Therefore, developing predictive biomarkers for infections after LTx is essential for the optimized care and precise immunotherapy of LTx patients [ 8 ].…”

Endocarditis in Liver Transplant Recipients: A Systematic Review

“…In recent decades, the development of liver transplantation both in terms of surgical techniques, as well as in terms of post-operative pharmacological care, has led to prolongation of survival and improvement of quality of life for patients with end-stage chronic liver disease [ 49 , 50 ]. Infections in patients with liver transplantation pose an important cause of morbidity and mortality [ 51 , 52 , 53 , 54 ]. However, even though several different infections have been described in these patients, there are scarce reports of IE in patients with liver transplantation [ 4 ].…”

From hepatitis A to E: A critical review of viral hepatitis

“…Patients with HBV that develop acute liver failure, decompensated liver cirrhosis or HCC can potentially undergo liver transplantation as ultimate therapy. In the setting of posttransplant immunosuppression, the rate of HBV recurrence is high with survival rates < 50% after 2 years if no preventive measures are taken[ 65 ]. Hence, based on donor and recipient serologies different strategies have been developed including the use of combination of HBV immunoglobulin during the anhepatic and postoperative phase when indicated, with indefinite use of high-genetic barrier nucleoside/nucleotide analogs demonstrating the lowest rates of HBV recurrence and post-transplant decompensation[ 66 ].…”