Infection In Liver Transplant Patients Research Articles

Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection

Evidence for an increased rate of bacterial infections in liver transplant patients with cytomegalovirus infection

Long‐term follow‐up of hepatitis C virus (HCV) infection in liver transplant patients

Chronic hepatitis represents a frequent event after orthotopic liver transplantation (OLT). To ascertain the influence of HCV infection on the clinical and histological outcome of these patients, we have investigated the long‐term outcome of 22 patients with end‐stage chronic liver disease undergoing liver transplant focusing the attention on the role of different HCV genotypes in determining recurrence and severity of post‐OLT liver disease. For all patients blood samples taken before OLT and 3 months, 1, 2 and 3 years after OLT were tested for antiHCV antibodies by two different enzyme‐linked immuno‐assays and by recombinant immuno‐blot II and for the presence and type of HCV RNA by nested PCR (5' untranslated region and core gene primers). Of the 16 pre‐OLT antiHCV‐positive patients, 14 (87.5%) had recurrence of HCV infection while 2 cleared HCV. Pre‐OLT genotype recurred in 11 of these 14 patients (2 genotype I, 8 genotype II ‐ in 1 case associated with genotype III and 1 genotype IV). Of the 6 pre‐OLT antiHCV‐negative patients, only 1 (16.6%) became persistently HCV‐infected, with genotypes I and II. The recurrence of genotype II strictly related with development of severe chronic hepatitis while genotype I and IV were associated with milder forms of liver disease and were more easily cleared.

Role of Polymerase Chain Reaction in the Diagnosis of Cytomegalovirus Infection in Liver Transplant Patients

Eighty-eight formalin-fixed, paraffin-embedded needle biopsies from 58 liver trans plant recipients were analyzed for the presence of cytomegalovirus (CMV) by light microscopy and the polymerase chain reaction (PCR). Twenty-seven biopsies were positive for CMV by both light microscopy and PCR, 41 were negative by both methods, 17 were positive by PCR only, and 3 were positive by light microscopy only. In the absence of cytomegalic cells, immunohistochemical staining was unable to detect CMV that could have been identified by PCR. Serum total bilirubin was higher in patients whose biopsies contained PCR (but not histologic) evidence of CMV infection. No evidence of association of the presence of CMV was found by either PCR or light microscopy with serum levels of aminotransferase or alkaline phosphatase, nor with histologic evidence of rejection or hepatitis. PCR was negative for CMV in 22 liver biopsies from immunocompetent individuals without evidence of hepatic dysfunction. Although PCR can detect the presence of CMV in the absence of cytomegalic cells, the clinical significance of PCR-proven, histologically undetectable CMV in the liver is undetermined. Int J Surg Pathol 2(3):221-226, 1995

The incidence of gram-negative bacterial and fungal infections in liver transplant patients treated with selective decontamination

We have used selective bowel decontamination in 145 consecutive patients undergoing liver transplantation. In these 145 patients undergoing initial transplantation, we have experienced 42 major bacterial infections in 37 patients. Only five patients have experienced a gram-negative infection and only 2 of 26 documented bacteremias were associated with gram-negative organisms. To date, we have experienced only one systemic Candida infection. These results suggest that selective bowel decontamination may play a major role in reducing the previously reported high incidence of gram-negative and Candida sepsis following liver transplantation.

Rapid Shell Vial Culture and Tissue Histology Compared With Serology for the Rapid Diagnosis of Cytomegalovirus Infection in Liver Transplantation

Sixty-six patients who had undergone 78 liver transplantations, with no detectable cytomegalovirus (CMV) infection before transplantation, were studied to assess the value of CMV serology compared with the rapid detection of the virus in shell vial cell cultures or histology for the diagnosis of (1) the first evidence of infection, (2) symptomatic disease, and (3) asymptomatic infection. Of 28 evaluable patients, shell vial cell culture assay and histologic findings provided the first evidence of CMV infection earlier in 22 (79%) or at the same time as the serologic response in 5 (18%). Serologic results yielded the first indication of CMV infection in only 1 of these 28 patients (3%). Of 17 evaluable transplantations in 15 patients in whom symptomatic invasive disease developed, shell vial culture or histology provided a laboratory diagnosis of CMV infection earlier or at the same time as serologic responses in 16 (94%). Similarly, shell vial culture or histology provided evidence of CMV infection in 10 of 11 patients (91%) who had asymptomatic CMV infection and remained asymptomatic. Urine surveillance cultures yielded the first evidence of CMV infection in 14 of 19 patients who initially had an asymptomatic infection, of which 6 became symptomatic. Culturing of the blood with use of the rapid shell vial technique showed that viremia preceded CMV organ involvement in 7 of 10 patients. We recommend culture by the shell vial assay as the most rapid and sensitive method of determining CMV infection in liver transplant patients.