Infections in liver transplant recipients

Table 1 Selected infections after liver transplantation

Time period after liver transplantation
1st mo	Between 1st and 6th mo	Beyond 6th mo
General risks: surgical procedure, prolonged hospitalization, prior colonization, mechanical ventilation, indwelling vascular and urinary catheterization, donor-transmitted diseases, among others	General risks: over-immunosuppression, D+/R- mismatch status for viruses, allograft rejection, donor-transmitted diseases, repeated biliary tract manipulations, re-transplantation	General risks: variable
		High-risk patients include those with recurrent rejection and allograft dysfunction that would require intense immunosuppression
Bacterial infections including resistant pathogens – bloodstream infections, pneumonia, surgical site infections, intra-abdominal infections, abscesses, urosepsis, Clostridium difficile associated colitis	Bacterial infections continue to occur in some patients – bloodstream infections, pneumonia, abdominal infections, C difficile associated colitis	Minimal immunosuppression – usual community acquired infections and zoster
Herpes simplex virus infection – herpes labialis or genitalis with potential for disseminated disease	Opportunistic pathogens: cytomegalovirus, Epstein-Barr virus, human herpesvirus 6 and 7, Aspergillus species, Pneumocystis jirovecii, Nocardia species, Mycobacterium tuberculosis, endemic mycoses, Toxoplasma gondii, among others	Intense immunosuppression due to allograft rejection and dysfunction – infections occurring during the opportunistic period (see middle column) continue to occur; course of chronic viral hepatitis may be accelerated
Candida sp. infections – fungemia, abscesses, urosepsis