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Risk factors for early viral infections after liver transplantation

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Abstract

Purpose

Viral infections represent a serious threat for patients after liver transplantation (LT). The identification of risk factors during the early post-transplant period might help to improve prevention of viral infections after LT.

Methods

Between 2004 and 2010, 530 adult patients underwent LT at a large university hospital serving a metropolitan region in Europe. This retrospective single-centre study analysed putative risk factors for early viral infections with herpes simplex virus-1 (HSV-1), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), hepatitis A/B/C (HAV/HBV/HCV) and cytomegalovirus (CMV) in the first 3 months after LT.

Results

The final analysis included 501 patients of whom 126 (25.1%) had documented viral infections after LT. No significant differences could be detected between patients with or without viral infections concerning 30- and 90-day mortality. Risk factors in the early post-transplant period identified by multivariate analysis included female gender (CMV, HSV-1), the post-operative need for continuous veno-venous hemofiltration (CMV), septic shock (CMV), detection of fungi (CMV) and the intraoperative amount of transfused blood (EBV).

Conclusions

Enhanced vigilance regarding opportunistic infections is crucial in the management of this high-risk population of immunocompromised patients. In particular, attention should be paid to avoidable conditions that increase the risk of renal replacement therapies in the post-LT setting, especially among women.

Trial registration

DRKS00010672 on German Clinical Trial Register

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Authors and Affiliations

  1. Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Cornelius Johannes Busch, Benedikt Hermann Siegler, Heike Werle, Christoph Lichtenstern, Markus Alexander Weigand & Marcel Hochreiter

  2. Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany

    Thomas Bruckner

  3. Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany

    Alexandra Heininger

  4. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Arianeb Mehrabi

  5. Department of Gastroenterology and Hepatology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Karl Heinz Weiss

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  1. Cornelius Johannes Busch
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Contributions

Busch CJ and Siegler BH contributed equally as the first authors in preparing the original work. Busch CJ: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. Siegler BH: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. Hochreiter M: Study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript. Werle H: Acquisition of data, drafting of manuscript, critical revision of manuscript. Bruckner T: Statistics, Analysis and interpretation of data, critical revision of manuscript. Lichtenstern C, Heininger A, Weiss KH, Mehrabi A and Weigand MA: drafting of manuscript, critical revision of manuscript.

Corresponding author

Correspondence to Marcel Hochreiter.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee (AZ S- 115 / 2008) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

Alexandra Heininger reports grants from Pall GmbH, Dreieich, Germany, personal fees from Bayer Vital GmbH and personal fees from Pfizer Pharma GmbH, during the conduct of the study. Christoph Lichtenstern reports speaker/advisory board fees and travel grants from Astellas, outside the submitted work. Benedikt Hermann Siegler reports travel grants from Astellas, outside the submitted work. Arianeb Mehrabi, Thomas Bruckner, Cornelius Johannes Busch, Marcel Hochreiter, Karl Heinz Weiss, Markus Alexander Weigand and Heike Werle declare that they have no conflict of interest.

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Busch, C.J., Siegler, B.H., Werle, H. et al. Risk factors for early viral infections after liver transplantation. Langenbecks Arch Surg 403, 509–519 (2018). https://doi.org/10.1007/s00423-018-1672-3

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