Skip to main content
SpringerLink
Log in

Infections and Sepsis After Liver Transplantation

  • Reference work entry
  • First Online:
Contemporary Liver Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

Abstract

Despite recent advances, infectious complications remain a significant contributor to morbidity and mortality after liver transplantation, affecting both patient and graft survival. Following transplantation, one third to one half of liver transplant recipients experience an infectious complication with over 80 % of infections occurring within the first 6 months following transplant. Infectious complications are the cause of death in over 15–25 % of all liver transplant recipients but are responsible for over half of deaths in the first year following transplant. Infection remains the most common cause of death for the first 3 years after liver transplant. Bacterial infections predominate and include presentations such as bloodstream, abdominal, wound, or biliary tract infection. Liver transplant patients are also particularly susceptible to fungal infections, predominantly candidemia, invasive aspergillosis, and cryptococcal infection. As with other high-risk populations, multidrug-resistant (MDR) organisms are becoming more prevalent after liver transplantation with an increased mortality than with drug-susceptible infections. With targeted pre-transplant and posttransplant prevention, prophylaxis, and monitoring, many infections may be prevented or identified early allowing for prompt initiation of appropriate therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Akamatsu N, Sugawara Y, Hashimoto D (2011) Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors, and outcome. Transpl Int 24:379–392

    Article  PubMed  Google Scholar 

  • Avkan-Oguz V, Ozkardesler S, Unek T et al (2013) Risk factors for early bacterial infections in liver transplantation. Transplant Proc 45:993–997

    Article  CAS  PubMed  Google Scholar 

  • Barchiesi F, Mazzocato S, Mazzanti S et al (2014) Invasive aspergillosis in liver transplant recipients: epidemiology, clinical characteristics, treatment, and outcome in 116 cases. Liver Transpl. doi:10.1002/lt.24032

    Google Scholar 

  • Bert F, Larroque B, Paugam-Burtz C et al (2010) Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: an analysis of 259 episodes. Liver Transpl 16:292–401

    Google Scholar 

  • Blair JE, Kusne S (2005) Bacterial, mycobacterial, and protozoal infections after liver transplantation – part I. Liver Transpl 11:1452–1459

    Article  PubMed  Google Scholar 

  • Brown RS Jr, Lake JR, Katzman BA et al (1996) Incidence and significance of Aspergillus cultures following liver and kidney transplantation. Transplantation 61:666–669

    Article  PubMed  Google Scholar 

  • Chen TC, Lin PC, Chi CY et al (2011) Infection in liver transplant recipients – analysis of 68 cases at teaching hospital in Taiwan. J Microbiol Immunol Infect 44:303–309

    Article  PubMed  Google Scholar 

  • Collins LA, Samore MH, Roberts MS et al (1994) Risk factors for invasive fungal infections complicating orthotopic liver transplantation. J Infect Dis 170:644–652

    Article  CAS  PubMed  Google Scholar 

  • Côté-Daigneault J, Carrier FM, Toledano K et al (2014) Herpes simplex hepatitis after liver transplantation: case report and literature review. Transpl Infect Dis 16:130–134

    Article  PubMed  Google Scholar 

  • Coucette KE, Al-Saif M, Kneteman N et al (2013) Donor-derived bacteremia in liver transplant recipients despite antibiotic prophylaxis. Am J Transplant 13:1080–1083

    Article  Google Scholar 

  • Cruciani M, Mengoli C, Malena M et al (2006) Antifungal prophylaxis in liver transplant patients: a systematic review and meta-analysis. Liver Transpl 12:850–858

    Article  PubMed  Google Scholar 

  • Danziger-Isakov L, Kumar D, The AST Infectious Diseases Community of Practice (2013) Vaccination in solid organ transplantation. Am J Transplant 13:311–317

    Article  CAS  PubMed  Google Scholar 

  • Dganga G, Spanu T, Bianco B et al (2012) Bacterial bloodstream infections in liver transplantation: etiologic agents and antimicrobial susceptibility profiles. Transplant Proc 44:1973–1976

    Article  Google Scholar 

  • Fagiuoli S, Colli A, Bruno R et al (2014) Management of infections pre- and post-liver transplantation: report of an AISF consensus conference. J Hepatol 60:1075–1089

    Article  PubMed  Google Scholar 

  • Falagas ME, Snydman DR, Griffith J et al (1996) Exposure to cytomegalovirus from the donated organ is a risk factor for bacteremia in orthotopic liver transplant recipients. Clin Infect Dis 23:468–474

    Article  CAS  PubMed  Google Scholar 

  • Fischer SA, Avery RK (2009) Screening of donor and recipient prior to solid organ transplantation. Am J Transplant 9:S7–S18

    Article  PubMed  Google Scholar 

  • Fischer SA, Lu K, The AST Infectious Diseases Community of Practice (2013) Screening of donor and recipient in solid organ transplantation. Am J Transplant 13:9–21

    Article  CAS  PubMed  Google Scholar 

  • Freire MP, Soares Oshiro IC, Bonazzi PR et al (2013) Surgical site infections in liver transplant recipients in the model for end-stage liver disease era: an analysis of the epidemiology, risk factors, and outcomes. Liver Transpl 19:1011–1019

    Article  PubMed  Google Scholar 

  • Fung JJ (2002) Fungal infection in liver transplantation. Transpl Infect Dis 4:18–23

    Article  PubMed  Google Scholar 

  • Garcia Prado ME, Matia EC, Ciuro FP et al (2008) Surgical site infection n liver transplant recipients: impact of the type of perioperative prophylaxis. Transplantation 85:1849–1854

    Article  PubMed  Google Scholar 

  • Garzoni C, Vergidis P, The AST Infectious Diseases Community of Practice (2013) Methicillin-resistant, vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections in solid organ transplantation. Am J Transplant 13:50–58

    Article  CAS  PubMed  Google Scholar 

  • Gastaca M (2012) Biliary complications after orthotopic liver transplantation: a review of incidence and risk factors. Transplant Proc 44:1545–1549

    Article  CAS  PubMed  Google Scholar 

  • George MJ, Snydman DR, Werner BG (1997) The independent role of cytomegalovirus as a risk factor for invasive fungal disease in orthotopic liver transplant recipients. Am J Med 103:106–113

    Article  CAS  PubMed  Google Scholar 

  • Gourishankar S, McDermid JC, Jhangri GS et al (2004) Herpes zoster infection following solid organ transplantation: incidence, risk factors, and outcomes in the current immunosuppressive era. Am J Transplant 4:108–115

    Article  PubMed  Google Scholar 

  • Gourishankar S, Doucette K, Fenton J et al (2008) The use of donor and recipient screening for toxoplasma in the era of universal trimethoprim-sulfamethoxazole prophylaxis. Transplantation 85:980–985

    Article  PubMed  Google Scholar 

  • Green M (2013) Introduction: infections in solid organ transplantation. Am J Transplant 13:3–8

    Article  CAS  PubMed  Google Scholar 

  • Greif F, Bronsther OL, Van Thiel DH et al (1994) The incidence, timing and management of biliary tract complications after orthotopic liver transplantation. Ann Surg 219:40–45

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hellinger WC, Crook JE, Heckman MG et al (2009) Surgical site infection after liver transplantation: risk factors and association with graft loss or death. Transplantation 87:1387–1393

    Article  PubMed  Google Scholar 

  • Hollenbeak CS, Alfrey EJ, Souba WW (2001) The effect of surgical site infections on outcomes and resource utilization after liver transplantation. Surgery 130:388–395

    Article  CAS  PubMed  Google Scholar 

  • Huprikar S (2007) Update in infectious diseases in liver transplant recipients. Clin Liver Dis 11:337–354

    Article  PubMed  Google Scholar 

  • Husain S, Wagener MM, Singh N (2001) Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis 7:375–381

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ignacio Herrero J, Quiroga J, Sangro B et al (2004) Herpes zoster after liver transplantation: incidence, risk factors, and complications. Liver Transpl 10:1140–1143

    Article  PubMed  Google Scholar 

  • Ison MG (2005) Respiratory viral infections in transplant recipients. Curr Opin Organ Transplant 5:2555–2559

    Google Scholar 

  • Ison MG (2006) Adenovirus infections in transplant recipients. Clin Infect Dis 43:331–339

    Article  PubMed  Google Scholar 

  • Ison MG, Grossi P, The AST Infectious Diseases Community of Practice (2013) Donor-derived infections in solid organ transplantation. Am J Transplant 13:22–30

    Article  PubMed  Google Scholar 

  • Kalpoe JS, Sonnenberg E, Factor SH et al (2012) Mortality associated with carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients. Liver Transpl 18:468–474

    Article  PubMed  Google Scholar 

  • Kerensky T, Hasan A, Schain D et al (2013) Histopathologic resolution of adult liver transplantation adenovirus hepatitis with cidofovir and intravenous immunoglobulin: a case report. Transplant Proc 45:293–296

    Article  CAS  PubMed  Google Scholar 

  • Kim SI (2014) Bacterial infection after liver transplantation. World J Gastroenterol 20:6211–6230

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim YJ, Kim SI, Wie SH et al (2008) Infectious complications in living-donor liver transplant recipients: a 9-year single-center experience. Transpl Infect Dis 10:316–324

    Article  CAS  PubMed  Google Scholar 

  • Kim HK, Park YK, HJ W et al (2013a) Epidemiology and clinical features of post-transplant bloodstream infection: an analysis of 222 consecutive liver transplant recipients. Infect Chemother 45(3):315–324

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kim SI, Kim YJ, Choi JY (2013b) Strategies to reduce infectious complications using epidemiologic data analysis in liver transplant recipients. Transplant Proc 45:3061–3064

    Article  CAS  PubMed  Google Scholar 

  • Kusne S, Pappo O, Manez R et al (1995) Varicella-zoster virus hepatitis and a suggested management plan for prevention of VZV infection in adult liver transplant recipients. Transplantation 60:619–621

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Le M, Ravin K, Hasan A et al (2014) Single donor-derived strongyloidiasis in three solid organ transplant recipients: case series and review of the literature. Am J Transplant 14:1199–1206

    Article  CAS  PubMed  Google Scholar 

  • Lee SO, Kang SH, Abdel-Massih RC et al (2011) Spectrum of early-onset and late-onset bacteremias after liver transplantation: implications for management. Liver Transpl 17:733–741

    Article  PubMed  PubMed Central  Google Scholar 

  • Levitsky J, Kalil A, Meza JL et al (2005) Herpes zoster infection after liver transplantation: a case – control study. Liver Transpl 11:320–325

    Article  PubMed  Google Scholar 

  • McGrath D, Falagas ME, Freeman R et al (1998) Adenovirus infection in adult orthotopic liver transplant recipients: incidence and clinical significance. J Infect Dis 177:459–462

    Article  CAS  PubMed  Google Scholar 

  • Mrzljak A, Peric Z, Kovacevic V et al (2010) Risk problem of multidrug-resistant gram-negative bacteria causing bloodstream infection after liver transplantation: how should we handle the issue? Liver Transpl 16:1217–1219

    Article  PubMed  Google Scholar 

  • Patel G, Hhuprikar S (2012) Infectious complications after orthotopic liver transplantation. Semin Respir Crit Care Med 33:11–124

    Article  Google Scholar 

  • Perfect JT, Dismukes WE, Dromer F et al (2010) Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 50:291–322

    Article  PubMed  Google Scholar 

  • Pfeiffer CD, Fine JP, Safdar N (2006) Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 42:1417–1427

    Article  CAS  PubMed  Google Scholar 

  • Rodriguez-Hernandez MJ, Ruiz-Perez-Pipaon M, Canas E et al (2009) Strongyloides stercoralis hyperinfection transmitted by liver allograft in a transplant recipient. Am J Transplant 9:2637–2640

    Article  CAS  PubMed  Google Scholar 

  • Romero FA, Razonable RR (2011) Infections in liver transplant recipients. World J Hepatol 3:83–92

    Article  PubMed  PubMed Central  Google Scholar 

  • Roque-Alfonso AM, Bralet MP, Ichai P et al (2008) Chickenpox-associated fulminant hepatitis that led to liver transplantation in a 63-year-old woman. Liver Transpl 14:1309–1312

    Article  Google Scholar 

  • Rubin RH (2002) The direct and indirect effects of infection in liver transplantation: pathogenesis, impact, and clinical management. Curr Clin Top Infect Dis 22:125–154

    PubMed  Google Scholar 

  • Safdar N, Said A, Lucey MR et al (2004) Infected bilomas in liver transplant recipients: incidence, risk factors, and implications for prevention. Am J Transplant 4:574–582

    Article  PubMed  Google Scholar 

  • Saliba F, Delvart V, Ichaї P et al (2013) Fungal infections after liver transplantation: outcomes and risk factors revisited in the MELD era. Clin Transplant 27:E454–E461

    Article  PubMed  Google Scholar 

  • Saner FH, Olde Damink SWM, Pavlakovic G et al (2008) Pulmonary and blood stream infections in adult living donor and cadaveric liver transplant patients. Transplantation 85:1564–1568

    Article  PubMed  Google Scholar 

  • San-Juan R, Aguado JM, Lumbreras C et al (2011) Universal prophylaxis with fluconazole for the prevention of early invasive fungal infection in low-risk liver transplant recipients. Transplantation 92:346–350

    Article  CAS  PubMed  Google Scholar 

  • Schwartz BS, Mawhorter SD, The AST Infectious Diseases Community of Practice (2013) Parasitic infections in solid organ transplantation. Am J Transplant 13:280–303

    Article  CAS  PubMed  Google Scholar 

  • Sganga G, Spanu T, Biano G et al (2012) Bacterial bloodstream infections in liver transplantation: etiologic agents and antimicrobial susceptibility profiles. Transplant Proc 44:1973–1976

    Article  CAS  PubMed  Google Scholar 

  • Shah H, Hellinger WC, Heckman MG et al (2014) Surgical site infections after liver retransplantation: incidence and risk factors. Liver Transpl 20:930–936

    Article  PubMed  Google Scholar 

  • Shi SH, Kong HS, Xu J et al (2009) Multidrug resistant gram-negative bacilli as predominant bacteremic pathogens in liver transplant recipients. Transpl Infect Dis 11:405–412

    Article  CAS  PubMed  Google Scholar 

  • Silveira FP, Kusne S (2013) Candida infections in solid organ transplantation. Am J Transplant 13:220–227

    Article  CAS  PubMed  Google Scholar 

  • Singh N (2003) Fungal infections in the recipients of solid organ transplantation. Infect Dis Clin N Am 17:113–134

    Article  Google Scholar 

  • Singh N, Paterson DL, Gayowski T et al (2000) Predicting bacteremia and bacteremic mortality in liver transplant recipients. Liver Transpl 6:54–61

    CAS  PubMed  Google Scholar 

  • Singh N, Averty RK, Munoz P et al (2003) Trends in risk profiles for and mortality associated with invasive aspergillosis among liver transplant recipients. Clin Infect Dis 36:46–52

    Article  PubMed  Google Scholar 

  • Singh N, Wagener MM, Obman A et al (2004) Bacteremias in liver transplant recipients: shift toward gram-negative bacteria as predominant pathogens. Liver Transpl 10:844–849

    Article  PubMed  Google Scholar 

  • Singh N, Limaye AP, Forrest G et al (2006) Late-onset invasive aspergillosis in organ transplant recipients in the current era. Med Mycol 44:445–449

    Article  CAS  PubMed  Google Scholar 

  • Singh N, Alexander BD, Lortholary O, The Cryptococcal Collaborative Transplant Study Group et al (2007) Cryptococcus neoformans in organ transplant recipients: impact of calcineurin-inhibitor agents on mortality. J Infect Dis 195:756–764

    Article  PubMed  PubMed Central  Google Scholar 

  • Singh N, Dromer F, Perfect JR et al (2008) Cryptococcosis in solid organ transplant recipients: current state of the science. Clin Infect Dis 47:1321–1327

    Article  PubMed  PubMed Central  Google Scholar 

  • Singh N, Husain S, The AST Infectious Diseases Community of Practice (2013) Aspergillosis in solid organ transplantation. Am J Transplant 13:228–241

    Article  CAS  PubMed  Google Scholar 

  • Sun HY, Alexander BD, Lortholary O, The Cryptococcal Collaborative Transplant Study Group et al (2010) Unrecognized pretransplant and donor-derived cryptococcal disease in organ transplant recipients. Clin Infect Dis 51:1062–1069

    Article  PubMed  Google Scholar 

  • van Duin D, van Delden C, The AST Infectious Diseases Community of Practice (2013) Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant 13:31–41

    Article  PubMed  Google Scholar 

  • Vera A, Contreras F, Guevara F (2011) Incidence and risk factors for infections after liver transplant: single-center experience at the University Hospital Fundación Santa Fe de Bogotá, Colombia. Transpl Infect Dis 13:608–615

    Article  CAS  PubMed  Google Scholar 

  • Wajszczuk CP, Dummer JS, Ho M et al (1985) Fungal infections in liver transplant recipients. Transplantation 40:347–353

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Watt KDS, Pedersen RA, Kremers WK et al (2010) Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transplant 10:1420–1427

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wendum D, Carbonell N, Svrcek M et al (2002) Fatal disseminated toxoplasmosis in a toxoplasma seropositive liver transplant recipient. J Clin Pathol 55:637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wilck MB, Zuckerman RA, The AST Infectious Diseases Community of Practice (2013) Herpes simplex virus in solid organ transplantation. Am J Transplant 13:121–127

    Article  CAS  PubMed  Google Scholar 

  • Winston DJ, Limare AP, Pelletier S et al (2014) Randomized, double-blind trial of anidulafungin versus fluconazole for prophylaxis of invasive fungal infections in high-risk liver transplant recipients. Am J Transplant. doi:10.1111/ajt.12963

    PubMed  Google Scholar 

  • www.unos.org. Accessed 15 Sep 2014

  • Zhong L, Men TY, Li H et al (2012) Multidrug-resistant gram-negative bacterial infections after liver transplantation – spectrum and risk factors. J Infect 64:299–310

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Washington Medical Center, Seattle, WA, USA

    Erika D. Lease

Authors
  1. Erika D. Lease
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erika D. Lease .

Editor information

Editors and Affiliations

  1. Nicoletti Family Professor of Transplant Surgery, Director, Jefferson Transplant Institute, Director, Division of Transplantation, Surgical Director, Kimmel Cancer Center – Jefferson Liver Tumor Center, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA

    Cataldo Doria

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this entry

Cite this entry

Lease, E.D. (2017). Infections and Sepsis After Liver Transplantation. In: Doria, C. (eds) Contemporary Liver Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07209-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-07209-8_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07208-1

  • Online ISBN: 978-3-319-07209-8

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation