Abstract
Liver transplant recipients are liable to many infectious and noninfectious chest complications, especially post-transplant pneumonia, which is the major cause of morbidity and mortality. Many studies have evaluated post-liver-transplant early-onset pneumonia. The aim of this study was to evaluate delayed-onset chest infections following liver transplantation. This prospective study was carried out on 50 adult living donor liver transplant recipients (mean age: 49.68±6.4 years; 44 men and six women). Delayed-onset chest infections that developed after the first month after transplant until the end of the first year were evaluated to determine their frequency, causative microorganisms, associated risk factors, and effect on mortality. Delayed-onset chest infections were detected in six patients (12%) and were complicated, with a 50% mortality rate. The causative organisms were carbapenemase-producing Enterobacteriaceae spp., multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Only one case was diagnosed as pleural tuberculosis in the late period of 6–12 months post liver transplantation. The mortality rate was significantly higher in patients who developed chest infections than among those who developed graft- related complications (P=0.009). Persistent moderate-to-large post-transplant transudative pleural effusion and the use of tacrolimus were associated with increased frequency of post-transplant delayed-onset chest infections (P=0.029 and 0.021, respectively). Despite the relatively low incidence of post-transplant delayed-onset pulmonary infections, they are a major cause of morbidity and mortality in liver transplant recipients. Tuberculosis should be considered as a cause of post-transplant delayed-onset chest infections.
Highlights
Liver transplantation (LT) is an accepted therapy for patients with end-stage liver disease
Delayed-onset chest infections were detected in six patients (12%) and were complicated, with a 50% mortality rate
The results of this study reported the development of delayed-onset chest infections in six patients (12%), which corresponds to that reported by Chen and colleagues, who performed a retrospective analysis of 68 LT recipients
Summary
Liver transplantation (LT) is an accepted therapy for patients with end-stage liver disease. Pulmonary morbidity and mortality are major concerns for LT recipients [1]. The goal of immunosuppressive regimens used in LT recipients is to optimize graft function by prevention of rejection with minimal side effects, especially opportunistic infections. Immunosuppressive agents are associated with opportunistic infections. There is individual variation in and difficulty in evaluation of the susceptibility of LT recipients to infections [2]. Many researchers have focused their studies on posttransplant early-onset pneumonia without evaluation of delayed-onset pneumonia because of the highest incidence of infections during this period being associated with initial intensive immunosuppression [1,3,4,5]. The aim of this study was to analyze delayedonset pulmonary infections as regards frequency, timing, causative microbial agent(s), associated risk factors, and associated mortality
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