Cytomegalovirus in Liver Transplant Patients

2021 ◽  
Vol 30 (3) ◽  
pp. 81-88
Author(s):  
Mahitab A. Youssef ◽  
Doaa T. Masallat ◽  
Ahmad M. Sultan ◽  
Sahar T. Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Bacterial Infections ◽  
Preventive Therapy ◽  
Meld Score ◽  
Cmv Infection ◽  
Post Transplantation ◽  
Transplant Patients ◽  
A Prospective Study

Background: Graft survival in liver transplant recipients is significantly lower in patients with a history of CMV infection compared to those without. In the absence of any preventive therapy 75% of recipients develop CMV infection post liver transplant. Objectives: This study detected the incidence of cytomegalovirus in liver transplant patients and evaluated post-transplant risk factors for HCMV and its complications. Methodology: A prospective study was conducted from the September 2018 till March 2020. Sixty subjects were involved; 30 patients were admitted for liver transplantation at the Gastroenterology Surgery Center (GISC), Mansoura university, and 30 donors. MELD score was calculated, blood samples were taken, CMV antibodies and CMV DNA were detected. Post transplantation follow up for 6 months and complications were reported. Results: HCMV viremia was detected in 46.6% recipients and in 10% donors by PCR. One recipient was positive for IgM and the rest were IgG positive and all donors were IgG positive. The most common reported complication after liver transplantation was bacterial infections (46.4%). Conclusions: Half of patients developed CMV infection after transplantation. The commonest risk factors for posttransplant CMV infection were seropositive donor or recipient >60 AU/mL, HCV patients, body mass index >25 and DM. Patients with positive HCMV infection had significantly higher MELD score than those reported negative HCMV

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

Pleural Effusions Following Liver Transplantation: A Single-Center Experience

2020 ◽  
pp. 088506662093244
Author(s):  
Justin K. Lui ◽  
Lidia Spaho ◽  
Shahrad Hakimian ◽  
Michael Devine ◽  
Rosa Bui ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Hospital Length Of Stay ◽  
Transplant Recipients ◽  
Single Center ◽  
Pleural Effusions ◽  
Post Transplantation ◽  
Significant Difference ◽  
Liver Transplant Recipients

Introduction: This was a single-center retrospective study to evaluate incidence, prognosis, and risk factors in patients with postoperative pleural effusions, a common pulmonary complication following liver transplantation. Methods: A retrospective review was performed on 374 liver transplantation cases through a database within the timeframe of January 1, 2009 through December 31, 2015. Demographics, pulmonary and cardiac function testing, laboratory studies, intraoperative transfusion/infusion volumes, postoperative management, and outcomes were analyzed. Results: In the immediate postoperative period, 189 (50.5%) developed pleural effusions following liver transplantation of which 145 (76.7%) resolved within 3 months. Those who developed pleural effusions demonstrated a lower fibrinogen (149.6 ± 66.3 mg/dL vs 178.4 ± 87.3 mg/dL; P = .009), total protein (5.8 ± 1.0 mg/dL vs 6.1 ± 1.2 mg/dL; P = .04), and hemoglobin (9.8 ± 1.8 mg/dL vs 10.3 ± 1.9 mg/dL; P = .004). There was not a statistically significant difference in 1-year all-cause mortality and in-hospital mortality between liver transplant recipients with and without pleural effusions. Liver transplant recipients who developed pleural effusions had a longer hospital length of stay (16.4 ± 10.9 days vs 14.0 ± 16.5 days; P = .1), but the differences were not statistically significant. However, there was a significant difference in tracheostomy rates (11.6% vs 5.4%; P = .03) in recipients who developed pleural effusions compared to recipients who did not. Conclusions: In summary, pleural effusions are common after liver transplantation and are associated with increased morbidity. Pre- and intraoperative risk factors can offer both predictive and prognostic value for post-transplantation pleural effusions. Further prospective studies will be needed to further evaluate the relevance of these findings to limit instances of postoperative pleural effusions.

scholarly journals Renal Safety of Tenofovir Disoproxil Fumarate and Entecavir in Liver Transplant Patients: A Nationwide Korean Registry Study

2021 ◽  
Author(s):  
Juhan Lee ◽  
Jae Geun Lee ◽  
Shin Hwang ◽  
Kwang-Woong Lee ◽  
Jong Man Kim ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Renal Dysfunction ◽  
Transplant Recipients ◽  
Post Transplantation ◽  
Transplant Patients ◽  
Increased Risk ◽  
B Virus ◽  
Liver Transplant Recipients ◽  
Renal Safety

Abstract Background and aims: Tenofovir disoproxil fumarate (TDF) and entecavir (ETV) have been recommended after liver transplantation to prevent recurrence of hepatitis B virus infection. Despite its proven efficacy, the renal safety of TDF has not been established in liver transplant recipients. We aimed to compare the effects of TDF and ETV on renal function in liver transplant recipients and to evaluate risk factors for renal dysfunction after liver transplantation. Methods: This is a retrospective, observational multicenter study of data from the Korean Organ Transplantation Registry. We included adults who underwent liver transplantation for hepatitis B virus-related complications from April 2014 to December 2017 and received TDF or ETV post-transplantation. Renal dysfunction was defined as an estimated glomerular filtration rate decline by at least 20% from baseline (1 month post-transplantation). Median duration of follow-up was 29 months (interquartile range 19–42).Results: A total of 804 liver transplant patients were included. The cumulative probability of renal dysfunction was significantly higher in the TDF group than in the ETV group. Multivariable analysis confirmed that TDF was independently associated with an increased risk of renal dysfunction (hazard ratio = 1.47, 95% confidence interval 1.12-1.92; P = 0.005). Independent risk factors for renal dysfunction included older age, worse baseline renal function, and low body mass index. Renal dysfunction after liver transplantation was independently associated with increased mortality.Conclusions: In this nationwide study, use of TDF was associated with an increased risk of renal dysfunction, when compared with ETV.

scholarly journals Association between donor and recipient Interleukin-18 gene polymorphisms and the risk of infection after liver transplantation

2017 ◽  
pp. E176-E187 ◽  
Author(s):  
Bao-Jie Shi ◽  
Xiao-Yu Yu ◽  
Hao Li ◽  
Tong-Hai Xing ◽  
Jun-Wei Fan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Bacterial Infection ◽  
Liver Transplant ◽  
Gene Polymorphisms ◽  
Bacterial Infections ◽  
Interleukin 18 ◽  
Donor Liver ◽  
Protein Levels ◽  
Transplant Patients ◽  
Increased Risk

Purpose: The purpose of this study was to retrospectively evaluate the association between Interleukin-18 (IL-18) gene polymorphisms of the donor and recipient in liver transplant patients with bacterial infections. Methods: Five single nucleotide polymorphisms (SNPs) (rs7106524, rs5744247, rs1946518, rs549908 and rs187238) of the IL-18 gene from the donors were genotyped and their association with post-operative bacterial infections was evaluated in liver transplant patients (N=113). A second independent group of liver transplant patients from a different organ transplant centre was also recruited for validation purposes (N=44). Results: IL-18 mRNA mean expression levels and protein levels were significantly lower in liver transplant patients with bacterial infections. For the donor SNP rs1946518, more recipients carried the A allele in the bacterial-infected group than the uninfected group (61.4% vs 39.7%; P ≤0.002). The mean IL-18 mRNA expression and protein levels were significantly lower in the transplanted livers of recipients carrying the rs1946518 AA genotype compared with those from recipients with CC genotype (3.64, 3.33 vs. 2.75, P≤0.048). The A allele of rs1946518 also resulted in lower luciferase activity than the C allele in a reporter assay. The area under ROC curve indicated that the rs1946518 SNP genotype in the donor liver predicted an increased risk of bacterial infection after liver transplantation (AUROC>0.82). Conclusions: These findings indicate that the IL-18 rs1946518 SNP in the donor liver is a risk factor for developing bacterial infection after liver transplantation.

Surgical Site Infections After Liver Transplantation: Prospective Surveillance and Evaluation of 250 Transplant Recipients in Canada

2017 ◽  
Vol 38 (9) ◽  
pp. 1084-1090 ◽  
Author(s):  
Yoichiro Natori ◽  
Rawan Kassar ◽  
Aled Iaboni ◽  
Seyed M. Hosseini-Moghaddam ◽  
James Vu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Surgical Site Infections ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Transplant Center ◽  
Observational Cohort ◽  
Independent Risk Factors ◽  
Liver Transplant Recipients

OBJECTIVETo evaluate the incidence of surgical-site infections (SSIs) in a cohort of liver transplant recipients and to assess risk factors predisposing patients to these infections.DESIGNProspective observational cohort study.SETTINGSingle transplant center in Canada.PATIENTSPatients who underwent liver transplantation between February 2011 and August 2014.METHODSMultivariate logistic regression was used to identify independent risk factors for SSIs in liver transplant patients.RESULTSWe enrolled 250 liver transplant recipients. The recipients’ median age at the time of transplantation was 56 years (range, 19–70 years), and 166 patients (66.4%) were male. Moreover, 47 SSIs were documented in 43 patients (17.2%). Organ-space, superficial, and deep SSIs were noted in 29, 7, and 3 patients, respectively. In addition, 2 patients developed superficial and organ-space SSIs, and another 2 patients were found to have deep as well as organ-space infections. In total, we identified 33 organ-space SSIs (70.2%), 9 superficial SSIs (19.1%), and 5 deep SSIs (10.6%). Factors predictive of SSIs by multivariate analysis were duct-to-duct anastomosis (odds ratio [OR], 3.88; 95% CI, 1.85–8.13; P<.001) and dialysis (OR, 3.57; 95% CI, 1.02–12.50; P=.046). Of the 66 organisms isolated in both deep and organ-space SSIs, 55 (83%) were resistant to cefazolin.CONCLUSIONSOrgan-space SSIs are a common complication after liver transplantation. Duct-to-duct anastomosis and dialysis were independent risk factors associated with SSIs. Appropriate perioperative prophylaxis targeting patients with duct-to-duct anastomosis and dialysis while simultaneously providing optimum coverage for the potential pathogens causing SSIs is warranted.Infect Control Hosp Epidemiol 2017;38:1084–1090

scholarly journals RISK FACTORS FOR POST-LIVER TRANSPLANT BILIARY COMPLICATIONS IN THE ABSENCE OF ARTERIAL COMPLICATIONS

2020 ◽  
Vol 33 (3) ◽  
Author(s):  
Agnaldo Soares LIMA ◽  
Bárbara Buitrago PEREIRA ◽  
Sven JUNGMANN ◽  
Carla Jorge MACHADO ◽  
Maria Isabel Toulson Davison CORREIA
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Bile Duct ◽  
Liver Transplant ◽  
Biliary Complications ◽  
Biliary Disease ◽  
Cmv Infection ◽  
Disease Manifestation ◽  
Duct Diameter ◽  
Arterial Complications

ABSTRACT Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.

scholarly journals Effect of "the Awakening Protocol" in the outcome of liver transplantation

2013 ◽  
Vol 28 (suppl 1) ◽  
pp. 72-76
Author(s):  
Agnaldo Soares Lima ◽  
Leandro Ricardo de Navarro Amado ◽  
Malvina Maria de Freitas Duarte ◽  
Marcelo Dias Sanches ◽  
Alexandre Prado de Resende ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Base Excess ◽  
Risk Index ◽  
Graft Loss ◽  
Early Morning ◽  
Meld Score ◽  
The Awakening ◽  
Transplant Patients ◽  
Surgical Tactics ◽  
Patient And Graft Survival

PURPOSE: To analyze mortality (7 days) or graft loss in liver transplantation (Tx) performed within the Awakening Protocol (AP) compared to sequential Tx. METHODS: Analysis of 243 liver tx (230 patients), divided into sequential tx or PD (early morning) to compare graft loss or death (7 days). Significant differences at p <0.05 RESULTS: The PD was adopted in 32.5% of tx. The cold ischemia time (p <0.01) and the interval until transplantation (p <0.01) were significantly different. Age of the donor and recipient, Donor Risk Index, MELD score, and donor base excess, sodium, creatinine and glucose were not different between groups. Previous abdominal surgery was a risk factor for early mortality, but was equally distributed between the groups. There was no difference in mortality or graft loss within 7 days (p = 0.521) CONCLUSION: The adoption of PD, to start tx the morning when harvesting occurs after 10p.m. did not result in worse patient and graft survival. Transplant patients with fulminant hepatic failure and high-risk grafts do not apply to this surgical tactics.

scholarly journals Determining risk factors for mortality in liver transplant patients with COVID-19

2020 ◽  
Vol 5 (7) ◽  
pp. 643-644 ◽  
Author(s):  
Gwilym J Webb ◽  
Andrew M Moon ◽  
Eleanor Barnes ◽  
A Sidney Barritt ◽  
Thomas Marjot
Keyword(s):  
Risk Factors ◽  
Liver Transplant ◽  
Transplant Patients
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