title: Infections in human liver recipients: different patterns early and late after transplantation.
abstract: The first 49 consecutive patients who underwent orthotopic liver transplantation between 1984 and 1989 in our department were studied with regard to symptomatic and asymptomatic post-transplantation infections. The major infections carrying a risk of fatal outcome are presented. During the first 4 weeks, fungal and bacterial infections predominated, the percentages of patients affected being 27% and 35%, respectively. Eight patients (17%) suffered from bacterial septicemia, which in six cases was due to gram-negative micro-organisms. The bacterial septicemia was often associated with severe ischemic damage to the graft, rejection, or cholangitis. In addition, a concomitant invasive fungal infection supervened in seven out of eight septic patients, further aggravating the patients' condition. Seventeen of the 49 patients (35%) died after transplantation within 3.3 years. Infection was the cause of death in nine patients (18%), with bacterial septicemia and/or fungemia in eight of these. Cytomegalovirus (CMV) disease was the dominant cause of illness after the 1st month. While only 5 of the 49 patients developed CMV disease during the 1st month (10%), as many as 16 of the 40 recipients who survived beyond that time suffered from symptomatic CMV viremia (40%). CMV mismatching, i.e., the donation of a CMV-positive organ to a CMV-seronegative recipient, entailed the highest risk for CMV disease. Pneumocystis carinii pneumonia occurred within 4 months in 10% of the patients. The four liver recipients affected were among the 20 patients not receiving trimethoprim-sulfamethoxazole prophylaxis. None of the 28 patients who received this prophylaxis over a 12-month period developed this complication (P < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Transplantation Surgery, Karolinska Institute, Huddinge Hospital, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Barkholt
authors.forename: B G
authors.initials: BG
authors.lastname: Ericzon
authors.forename: J
authors.initials: J
authors.lastname: Tollemar
authors.forename: A S
authors.initials: AS
authors.lastname: Malmborg
authors.forename: A
authors.initials: A
authors.lastname: Ehrnst
authors.forename: H
authors.initials: H
authors.lastname: Wilczek
authors.forename: J
authors.initials: J
authors.lastname: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology*; D011183:Postoperative Complications; D014777:Virus Diseases / Q000209:etiology*