title: Management of infections pre- and post-liver transplantation: report of an AISF consensus conference.
abstract: The burden of infectious diseases both before and after liver transplantation is clearly attributable to the dysfunction of defensive mechanisms of the host, both as a result of cirrhosis, as well as the use of immunosuppressive agents. The present document represents the recommendations of an expert panel commended by the Italian Association for the Study of the Liver (AISF), on the prevention and management of infectious complications excluding hepatitis B, D, C, and HIV in the setting of liver transplantation. Due to a decreased response to vaccinations in cirrhosis as well as within the first six months after transplantation, the best timing for immunization is likely before transplant and early in the course of disease. Before transplantation, a vaccination panel including inactivated as well as live attenuated vaccines is recommended, while oral polio vaccine, Calmette-Guerin's bacillus, and Smallpox are contraindicated, whereas after transplantation, live attenuated vaccines are contraindicated. Before transplant, screening protocols should be divided into different levels according to the likelihood of infection, in order to reduce costs for the National Health Service. Recommended preoperative and postoperative prophylaxis varies according to the pathologic agent to which it is directed (bacterial vs. viral vs. fungal). Timing after transplantation greatly determines the most likely agent involved in post-transplant infections, and specific high-risk categories of patients have been identified that warrant closer surveillance. Clearly, specifically targeted treatment protocols are needed upon diagnosis of infections in both the pre- as well as the post-transplant scenarios, not without considering local microbiology and resistance patterns.
authors.affiliation: Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, Bergamo, Italy. Electronic address: sfagiuoli@hpg23.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.affiliation: Medical Area Department, Lecco Hospital, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Colli
authors.affiliation: Department of Infectious Diseases, IRCCS San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bruno
authors.affiliation: Gastroenterology and Hepatology, Di.Bi.M.I.S., University of Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
authors.affiliation: Infectious Diseases, Department of Internal and Experimental Medicine, Second University of Naples, Italy.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Gaeta
authors.affiliation: Infectious & Tropical Diseases Unit, Department of Surgical & Morphological Sciences, Insubria University, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Grossi
authors.affiliation: Research Laboratories, Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo and Department of Internal Medicine, University of Pavia, Italy.
authors.forename: Mario U
authors.initials: MU
authors.lastname: Mondelli
authors.affiliation: Infectious Diseases Department, Niguarda Cà Granda Hospital, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
authors.affiliation: Department of Mental Health and Preventive Medicine, Second University of Naples, Italy.
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.affiliation: Department of Bio-Medical Sciences, Section of Microbiology, University of Catania, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.affiliation: Department of Medical Sciences, Experimental and Clinical, Medical Liver Transplant Section, Internal Medicine, University of Udine, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Toniutto
authors.affiliation: Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
mesh_terms: D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D007558:Italy; D008103:Liver Cirrhosis / Q000150:complications / Q000276:immunology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D014181:Transplantation Immunology; D014611:Vaccination; D014837:Voluntary Health Agencies
keywords: Bacterial infections; Cirrhosis; Invasive fungal infections; Liver transplantation; Viral infections