Prevention of fungal and hepatitis virus infections in liver transplantation

Invasive fungal infections, especially those caused by Candida albicans, an d recurrence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infecti on after transplantation are common complications in orthotopic liver trans plant (OLT) recipients. Candida species account for >50% of all invasive fu ngal infections, which occur in 10%-15% of OLT recipients. The epidemiology and pathogenesis of invasive fungal infections are unique to each type of organism. Fluconazole is effective and safe in the prevention of Candida in fection after OLT. Preventive measures against Aspergillus or Cryptococcus remain ill defined. Both HBV and HCV recur almost universally after OLT in infected individuals. The natural course of HBV and HCV, leading to endstag e liver damage, is accelerated. In OLT patients, administration of immunogl obulin with high titers against HBV, alone and/or in combination with lamiv udine, immediately after transplantation reduces the recurrence of HBV. The combination of interferon and ribavirin is mildly effective in OLT patient s who have evidence of recurrent hepatitis, and additional alternatives are being evaluated.