title: Infectious agents after liver transplant: etiology, timeline and patients' cell-mediated immunity responses.
abstract: Infections continue to be one of the leading causes of morbidity and mortality in liver transplant recipients. We retrospectively reviewed the symptomatic infectious episodes that occurred during the first year post-transplant to determine time of onset, causative pathogens and cell-mediated immunity response patterns. Ninety-eight of the 202 (48.5%) recipients enrolled developed at least one infectious episode. The total number of infectious episodes was 135: 77 (57.1%) bacterial, 45 (33.3%) viral and 13 (9.6%) fungal. The most frequently isolated bacteria were Escherichia coli (21 isolates) and Klebsiella pneumoniae (19 isolates). Overall, extended-spectrum beta lactamase-producing and methicillin-resistant organisms were responsible for 29 (29/77; 37.7%) infectious episodes. Members of the herpes virus group, in particular cytomegalovirus (34/45 viral infections, 75.5%), were detected. Candida species (9 isolates) followed by Aspergillus species (4 isolates) were isolated. The majority of infections (63%) occurred during the early post-transplant phase (<1 month), whereas only 8/135 episodes (5.9%) were detected after the sixth month (late phase). Significantly lower median ImmuKnow®intracellular ATP values in patients who developed bacterial and fungal infections compared to infection-free patients were observed (P < 0.0001 and P = 0.0016, respectively), whereas patients who developed a viral infection had a median intracellular ATP level not statistically different compared to uninfected patients (P = 0.4). Our findings confirm that bacteria are responsible for the majority of symptomatic infections and occur more frequently during the first month post-transplant. The ImmuKnow®measurements can be a useful tool for identifying patients at high risk of developing infection, particularly of fungal and bacterial etiology.
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Angela
authors: A
authors: Chiereghin
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.|Italian National Transplant Centre - Italian National Institute of Health, Via Giano Della Bella 34, 00162, Rome, Italy.
authors: Evangelia
authors: E
authors: Petrisli
authors: Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Matteo
authors: M
authors: Ravaioli
authors: Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Maria Cristina
authors: MC
authors: Morelli
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Gabriele
authors: G
authors: Turello
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Diego
authors: D
authors: Squarzoni
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Giulia
authors: G
authors: Piccirilli
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Simone
authors: S
authors: Ambretti
authors: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Liliana
authors: L
authors: Gabrielli
authors: Department of General Surgery and Transplantation, St. Orsola-Malpighi University Hospital, Via Massarenti 9, 40138, Bologna, Italy.
authors: Antonio Daniele
authors: AD
authors: Pinna
authors: Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
authors: Maria Paola
authors: MP
authors: Landini
authors: Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy. tiziana.lazzarotto@unibo.it.
authors: Tiziana
authors: T
authors: Lazzarotto
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D003141:Communicable Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D003600:Cytosol / Q000737:chemistry; D004198:Disease Susceptibility; D005260:Female; D005658:Fungi / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007111:Immunity, Cellular; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012969:Sodium Fluoride; D066027:Transplant Recipients; D014520:Urethane / Q000031:analogs & derivatives; D014780:Viruses / Q000145:classification / Q000302:isolation & purification; D055815:Young Adult
chemical_list: C069856:TimeLine; D014520:Urethane; D000255:Adenosine Triphosphate; D012969:Sodium Fluoride
keywords: Cellular immunity; ImmuKnow® assay; Immunological monitoring; Liver transplant recipients; Pathogens