title: Infections after orthotopic liver transplantation.
abstract: Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management.
authors.affiliation: University of Arizona College of Medicine Phoenix, Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ 85006, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Pedersen
authors.affiliation: University of Arizona College of Medicine Phoenix, Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ 85006, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Seetharam
keywords: BAL, bronchoalveolar lavage; CMV, cytomegalovirus; EBV, epstein–Barr virus; ELISA, enzym linked immunosorbent assay; FCN2, ficolin-2; GM, galactomannan; HAT, hepatic artery thrombosis; HBIG, hepatitis B immune globulin; HBV, hepatitis B virus; HCV, hepatitis C virus; HHV, human herpesvirus; LDLT, live donor liver transplantation; MASP2, MBL-associated serine protease; MBL, mannan-binding lectin; MDR, multi-drug resistant; MELD, model for end-stage liver disease; NAS, non-anastomotic stricture; OLT, orthotopic liver transplantation; PPD, purified protein derivative; PTLD, post-transplant lymphoproliferative disorder; SNP, single nucleotide polymorphism; TLR, toll-like receptor; U, unit; cytomegalovirus; donor transmission; infection; liver transplantation; prophylaxis