title: Incidence, distribution, and outcome of episodes of infection in 100 orthotopic liver transplantations.
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.
authors.affiliation: Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
authors.forename: P E
authors.initials: PE
authors.lastname: Hermans
authors.forename: J A
authors.initials: JA
authors.lastname: Washington
authors.forename: T F
authors.initials: TF
authors.lastname: Smith
authors.forename: J P
authors.initials: JP
authors.lastname: Anhalt
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005500:Follow-Up Studies; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D011292:Premedication; D018805:Sepsis / Q000382:microbiology; D014777:Virus Diseases / Q000453:epidemiology* / Q000209:etiology