Abstract
Objectives
Liver transplant recipients are liable to many infectious and noninfectious chest complications, especially post-transplant pneumonia, which is the major cause of morbidity and mortality. Many studies have evaluated post-liver-transplant early-onset pneumonia. The aim of this study was to evaluate delayed-onset chest infections following liver transplantation.
Materials and methods
This prospective study was carried out on 50 adult living donor liver transplant recipients (mean age: 49.68±6.4 years; 44 men and six women). Delayed-onset chest infections that developed after the first month after transplant until the end of the first year were evaluated to determine their frequency, causative microorganisms, associated risk factors, and effect on mortality.
Results
Delayed-onset chest infections were detected in six patients (12%) and were complicated, with a 50% mortality rate. The causative organisms were carbapenemase-producing Enterobacteriaceae spp., multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Only one case was diagnosed as pleural tuberculosis in the late period of 6–12 months post liver transplantation. The mortality rate was significantly higher in patients who developed chest infections than among those who developed graft- related complications (P=0.009). Persistent moderate-to-large post-transplant transudative pleural effusion and the use of tacrolimus were associated with increased frequency of post-transplant delayed-onset chest infections (P=0.029 and 0.021, respectively).
Conclusion
Despite the relatively low incidence of post-transplant delayed-onset pulmonary infections, they are a major cause of morbidity and mortality in liver transplant recipients. Tuberculosis should be considered as a cause of post-transplant delayed-onset chest infections.
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References
Lin YH, Cai ZS, Jiang Y, Lü LZ, Zhang XJ, Cai QC. Perioperative risk factors for pulmonary complications after liver transplantation. J Int Med Res 2010;38:1845–1855.
Green M. Introduction: infections in solid organ transplantation. Am J Transplant 2013;13:S3–S8.
Xia D, Yan LN, Xu L, Li B, Zeng Y, Wen TF et al. Postoperative severe pneumonia in adult liver transplant recipients. Transplant Proc 2006;38:2974–2978.
Weiss E, Dahmani S, Bert F, Janny S, Sommacale D, Dondero F et al. Early onset pneumonia after liver transplantation: microbiological findings and therapeutic consequences. Liver Transpl 2010;16:1178–1185.
Ikegami T, Shirabe K, Matono R, Yoshizumi T, Soejima Y, Uchiyama H et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation. Liver Transpl 2012;18:1060–1068.
Pugh RNH, Murray Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–649.
Wiesner RH, Rakela J, Ishitani MB, Mulligan DC, Spivey JR, Steers JL et al. Recent advances in liver transplantation. Mayo Clinic Proc 2003;78:197–210.
American Thoracic Society and Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388–416.
Tai DYH. Bronchoscopy in the intensive care unit (ICU). Ann Acad Med Singap 1998;27:552–559.
Tsangaris I, Lekka ME, Kitsiouli E, Constantopoulos S, Nakos G. Bronchoalveolar lavage alterations during prolonged ventilation of patients without acute lung injury. Eur Respir J 2003;21:495–501.
Thille AW, Esteban A, FernaÌ ndez-Segoviano P, Rodriguez J, Aramburu J, Peñuelas O et al. Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med 2013;187:761–767.
Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J et al. Surviving Sepsis Campaign: The Surviving Sepsis Campaign: Results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med 2010;38:367–374.
Sahn SA. Approach to patients with pleural diseases.In Light RW, Lee YC, editors. Textbook of pleural disease. London, MA: Hodder Arnold; 2008. 201–207.
Sahn S, Heffner JE. Pleural fluid analysis. In Light RW, Lee YC, editors. Textbook of pleural disease. London, MA: Hodder Arnold; 2008. 209–226.
Perez-Rodriguez E, Light RW. Effusions from infections: tuberculosis. In Light RW, Lee YC, editors. Textbook of pleural disease. London, MA: Hodder Arnold; 2008. 367–378.
Colt H. Drainage techniques. In Light RW, Lee YC, editors. Textbook of pleural disease. London, MA: Hodder Arnold; 2008. 551–567.
Loddenkemper R. Medical thoracoscopy. In Light RW, Lee YC, editors. Textbook of pleural disease. London, MA: Hodder Arnold; 2008. 583–597.
Alaniz C, Regal RE. Spontaneous bacterial peritonitis: a review of treatment options. Pharm Ther 2009;34:204–210.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204–R212.
Li GS, Ye QF, Xia SS, Chen ZS, Zeng FJ, Lin ZB et al. Acute respiratory distress syndrome after liver transplantation: etiology, prevention and management. Hepatobiliary Pancreat Dis Int 2002;1:330–334.
Mohamoud YA, Mumtaz GR, Riome S, Miller D, Abu-Raddad LJ. The epidemiology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC infectious diseases 2013;13:288.
Denniston MM, Jiles RB, Drobeniuc J, Klevens RM, Ward JW, McQuillan GM et al. Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Ann Intern Med 2014;160:293–300.
Chen TC, Lin PC, Chi CY, Ho CM, Chou CH, Ho MW et al. Infection in liver transplant recipients - analysis of 68 cases at teaching hospital in Taiwan. J Microbiol Immunol Infect 2011;44:303–309.
Golfieri R, Giampalma E, Morselli Labate AM, d’Arienzo P, Jovine E, Grazi GL et al. Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases. Eur Radiol 2000;10:1169–1183.
Ez Elregal HG. The impact of pulmonary dysfunctions and diseases on the outcome of living donor liver transplantation (Medical Doctoral thesis) Ain Shams University. 2014.
Cisneros JM, Cordero E, Pachón J. Pneumonia in non-neutropenic immunocompromised patients. In Kollef M, Díaz E, Rodríguez A, editors. Infectious diseases in critical care. Germany: Springer; 2007. 427–434.
Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol 2011; 3: 83–92.
Zhong L, Men TY, Li H, Peng ZH, Gu Y, Ding X et al. Multidrug-resistant gram-negative bacterial infections after liver transplantation - spectrum and risk factors. J Infect 2012;64:299–310.
Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev 1997;10:86–124.
Russell DL, Flood A, Zaroda TE, Acosta C, Riley MM, Busuttil RW et al. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 2008;8:1737–1743.
Herati RS, Blumberg EA. Losing ground: multidrug-resistant bacteria in solid-organ transplantation. Curr Opin Infect Dis 2012;25:445–449.
Wadhawan M, Kumar A, Gupta S, Goyal N, Shandil R, Taneja S et al. Post transplant biliary complications: an analysis from a predominantly living donor liver transplant center. J Gastroenterol Hepatol 2013;28:1056–1060.
Osorio G, Quevedo E, Castañeda JA, Isaza SM, Pérez JC, Marín JI et al. Description of cellular rejection in liver transplant patients at the Hospital Pablo Tobón Uribe 2005–2010. Rev Col Gastroenterol 2013;28:108–113.
Valdez-Ortiz R, Sifuentes-Osornio J, Morales-Buenrostro LE, Ayala-Palma H, Dehesa-López E, Alberú J et al. Risk factors for infections requiring hospitalization in renal transplant recipients: a cohort study. Int J Infect Dis 2011;15:e188–e 196.
Dumortier J, Bernard S, Bouffard Y, Boillot O. Conversion from tacrolimus to cyclosporine in liver transplanted patients with diabetes mellitus. Liver Transplant 2006;12:659–664.
Scheffert JL, Raza K. Immunosuppression in lung transplantation. J Thorac Dis 2014;6:1039–1053.
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El-Badrawy, M.K., Ali, R.EM., Yassen, A.M. et al. Delayed-onset chest infections in liver transplant recipients: a prospective study. Egypt J Bronchol 10, 147–154 (2016). https://doi.org/10.4103/1687-8426.184362
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DOI: https://doi.org/10.4103/1687-8426.184362