MAJOR INFECTIOUS COMPLICATIONS AFTER ORTHOTOPIC LIVER-TRANSPLANTATIONAND COMPARISON OF OUTCOMES IN PATIENTS RECEIVING CYCLOSPORINE OR FK506 AS PRIMARY IMMUNOSUPPRESSION

A retrospective cohort study was conducted to determine the incidence of major infectious complications after orthotopic liver transplantati on and to compare outcomes in patients receiving either cyclosporine ( CsA) or FK506 (tacrolimus) as primary immunosuppression. Of 133 transp lants performed in 118 patients, 124 transplant episodes were evaluate d. Cytomegalovirus (CMV) infection (INF) and disease (DIS), deep funga l infection (DFI), and intraabdominal bacterial infections (IAI) were catalogued. The overall incidences of major infectious outcomes were: CMV INF = 33%; CMV DIS = 19%; DFI = 15%; and LAI = 25%. Cox proportion al hazard analysis identified donor seropositivity, OKT3 as secondary immunosuppression and initial intensive care unit (ICU) duration as ri sk factors for CMV INF and DIS in the overall population. Fungal colon ization was the dominant risk factor associated with deep fungal infec tion. A choledochojejunostomy anastomosis, the number of cellular bloo d products transfused at the time of transplantation surgery, and prio r CMV INF were independent risk factors for both fungal colonization a nd deep infection. The single risk factor identified for intraabdomina l bacterial infections was the number of cellular blood products trans fused at the time of surgery. In the Cox proportional hazards model th e relative risk (RR) for each category of infection was lower in the F K506 group (CMV: RR = .87, 95% confidence interval [C.I.] = [.32-2.4]; DFI: .58 [.13-2.6]; IAI: .51 [.15-1.7]), but the effect was not stati stically significant. Survival was similar in patients receiving FK506 or CsA. CMV INF and DFI were independent predictors of death for all patients, Risk factors identified for CMV INF and DIS support the find ings of others. Higher intraoperative blood product requirements and c omplicated intraoperative or postoperative courses increase the risk f or IAI or DFI. The development of effective strategies to prevent CMV and fungal infections in liver transplant recipients remains a priorit y for future endeavors.