title: Infectious complications limit the outcome of liver transplantation in medical urgency code 2 patients.
abstract: The Organ shortage has caused an accumulation of acutely decompensated patients listed as medical urgency code 2 (MUC 2) (United network for Organ Sharing 2) while awaiting liver transplantation. Between June 1997 and June 2003, 22 of 360 liver transplantation patients (6%) were listed as MUC 2. Prophylactic immunosuppression consisted of calcineurin inhibitor-based drug therapy, using antithymocyte globulin or interleukin-2 receptor antagonist induction in 64%. The overall perioperative infection rate was 50%, and the rejection rate was 23%. We observed 7 episodes of oral or genital herpes simplex virus lesions; 2 patients (both with cytomegalovirus-mismatched transplants) developed cytomegalovirus disease, and another 5 patients received ganciclovir for preemptive therapy or prophylaxis. Two patients developed pneumonia: 5, sepsis that originated in 4 cases from a contaminated central venous line; and 1 methicillin-resistant endocarditis, which resulted in Staphylococcus aureus lethal outcome. After a median follow up of 3 years, 1 patient underwent a repeat transplantation procedure and 6 patients had died, 4 of them from infectious complications. Liver transplantation of MUC 2-listed patients may result in acceptable results similar to those of MUC 3 and MUC 4 categories.
authors.affiliation: Department of General and Transplant Surgery University Hospital Innsbruck, Innsbruck, Austria. walter.mark@uibk.ac.at
authors.forename: W
authors.initials: W
authors.lastname: Mark
authors.forename: I
authors.initials: I
authors.lastname: Graziadei
authors.forename: D
authors.initials: D
authors.lastname: Bargehr
authors.forename: W
authors.initials: W
authors.lastname: Vogel
authors.forename: C
authors.initials: C
authors.lastname: Boesmueller
authors.forename: W
authors.initials: W
authors.lastname: Tabarelli
authors.forename: A
authors.initials: A
authors.lastname: Pomarolli
authors.forename: R
authors.initials: R
authors.lastname: Ladumer
authors.forename: W
authors.initials: W
authors.lastname: Steurer
authors.forename: A
authors.initials: A
authors.lastname: Koenigsrainer
authors.forename: R
authors.initials: R
authors.lastname: Margreiter
authors.forename: H
authors.initials: H
authors.lastname: Bonatti
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007239:Infections / Q000453:epidemiology*; D016030:Kidney Transplantation; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016019:Survival Analysis