M. Montejo et al., Infection after orthotopic liver transplantation: analysis of the first 120 consecutive cases, REV CLIN ES, 200(5), 2000, pp. 245-251
Objective. To report the infectious complications and presentation time of
the first 120 consecutive liver transplants performed at our institution.
Methods. Prospective study of infectious complications among 120 consecutiv
e adult patients who received orthotopic liver transplantation at Hospital
de Cruces, from February 1996 to November 1998. Two patients received a ren
al transplant concomitantly. The same surveillance protocols were used for
all patients and the criteria used to define infections were those reported
by other authors.
Results. The group consisted of 120 patients, 95 males and 25 females. The
age ranged from 20 and 66; years (mean: 54 +/- 9 years). The indications fo
r transplantation included alcoholic cirrhosis (47%), HCV cirrhosis (20%),
hepatocellular carcinoma (17.5%), fulminant hepatitis (6%), primary biliary
cirrhosis (2.5%) and miscellaneous conditions (7%). Three patients require
d retransplantation. Acute rejection was histologically diagnosed in 38 pat
ients (31%). None of the patients had corticosteroid-resistant rejection. F
ifty-one patients (42.5%) developed 76 episodes of severe infection, which
included: 48 episodes of bacterial infection among 33 patients (27.5%), tub
erculosis in 7 patients (6%), 9 episodes of fungal infection among 8 patien
ts (7%) and cytomegalovirus (CMV) infection among 8.5% of patients. No pati
ent developed Pneumocystis carinii pneumonia. Fifteen (12.5%) patients died
: six (12.5%) with active infection, and in four of them the infection was
considered the cause of death.
Conclusions. Infection rates due to bacteria and fungi were similar to thos
e reported in the literature. A high rate of tuberculosis was found, which
possible correlated with the high incidence of this disease in the general
population. The low incidence of CMV infection was probably due to the pree
mptive therapy with gancyclovir. Trimethoprimsulfamethoxazol prophylaxis ag
ainst Pneumocystis carinii was highly effective.