Incidence, Distribution, and Outcome of Episodes of Infection in 100 Orthotopic Liver Transplantations

CARLOS V. PAYA, PAUL E. HERMANS, JOHN A. WASHINGTON, THOMAS F. SMITH, JOHN P. ANHALT, RUSSELL H. WIESNER, RUUD A.F. KROM

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206 Scopus citations

Abstract

Of 83 patients who underwent 100 orthotopic liver transplantations, 53 had a single transplant procedure and at least 6 months of follow-up. In this main study group of 53 patients, major infections developed in 28 (53%) (a mean of 1.8 major episodes per infected patient). Of 51 major infections, 27 were bacterial, 19 were viral, 3 were protozoan, and 2 were fungal. Of the 27 bacterial infections, 22 (81%) occurred in the first 2 months after transplantation. Of the 40 bacterial isolates in the 27 bacterial infections, gram-positive aerobic bacteria were isolated in 26 (65%), anaerobic bacteria in 8 (20%), and aerobic gram-negative bacteria in 6 (15%). Only 1 of 16 bacteremic episodes was due to a gram-negative aerobic bacterium. Cytomegalovirus (CMV) infection occurred in 30 of the 53 patients (57%) and was symptomatic and invasive in 18. CMV infection was diagnosed a mean of 26 days after transplantation. Infections due to Pneumocystis carinii occurred later (2 to 3 months after transplantation). Death from infection occurred in 4 of the 53 patients (8%). In the group of 16 patients with two or more liver transplantations, fungal infection occurred in 2 and CMV infection in 13. In all 16 patients who underwent more than one liver transplantation, a major infection developed. The observations made in the main study group were consistent with findings in 13 patients with one liver transplantation but less than 6 months of follow-up. Infection is a major complication after liver transplantation, generally occurring in the first 2 months. Our observations suggest that the use of selective bowel decontamination may be associated with a relatively lower incidence of gram-negative aerobic bacterial infections.

Original languageEnglish (US)
Pages (from-to)555-564
Number of pages10
JournalMayo Clinic proceedings
Volume64
Issue number5
DOIs
StatePublished - Jan 1 1989

ASJC Scopus subject areas

  • Medicine(all)

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    PAYA, CARLOS. V., HERMANS, PAUL. E., WASHINGTON, JOHN. A., SMITH, THOMAS. F., ANHALT, JOHN. P., WIESNER, RUSSELL. H., & KROM, RUUD. A. F. (1989). Incidence, Distribution, and Outcome of Episodes of Infection in 100 Orthotopic Liver Transplantations. Mayo Clinic proceedings, 64(5), 555-564. https://doi.org/10.1016/S0025-6196(12)65561-X