Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2025; 17(7): 107213
Published online Jul 27, 2025. doi: 10.4254/wjh.v17.i7.107213
Challenges of Klebsiella pneumoniae infections post-liver transplantation: Insights and future directions
Jian Li, Wei Wang
Jian Li, Wei Wang, Department of Interventional Oncology, Municipal Hospital Affiliated to Taizhou University, Taizhou 318000, Zhejiang Province, China
Author contributions: Li J methodology and formal analysis; Wang W conceptualization, writing, reviewing and editing; All authors participated in drafting the manuscript and all have read, contributed to, and approved the final version of the manuscript.
Supported by the Second Batch of Social Development Science and Technology Program Projects of Taizhou Science and Technology Bureau in 2023, No. 24ywb80.
Conflict-of-interest statement: Every author has stated that there is no commercial, professional, or personal conflict of interest relevant to the study, proving that it complies with the principles of publishing ethics.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Wang, MD, Associate Professor, Department of Interventional Oncology, Municipal Hospital Affiliated to Taizhou University, No. 381-1 Zhongshan East Road, Jiaojiang District, Taizhou 318000, Zhejiang Province, China. westernfox000@163.com
Received: March 18, 2025
Revised: April 13, 2025
Accepted: June 25, 2025
Published online: July 27, 2025
Processing time: 129 Days and 13.7 Hours
Abstract

Klebsiella pneumoniae infections (KPIs), particularly carbapenem-resistant Klebsiella pneumoniae (CRKP), pose significant challenges in liver transplantation (LT) recipients, with high morbidity and mortality. Guo et al’s study highlights risk factors, such as elevated day-one alanine aminotransferase levels and prolonged catheterization, and identifies polymyxin B and ceftazidime/avibactam as effective treatments. However, limitations like the absence of pre-transplant colonization data and host-pathogen interaction insights highlight the need for enhanced strategies. Future directions should include routine CRKP colonization surveillance, immune and genomic profiling, and the development of novel therapeutics. By integrating these approaches, we can improve the prevention, diagnosis, and treatment of KPIs in LT patients.

Keywords: Antimicrobial resistance; Host-pathogen interactions; Immunomodulatory therapies; Klebsiella pneumoniae; Liver transplantation; Microbial genomics; Polymyxin B; Pre-transplant surveillance; Therapeutic strategies

Core Tip: Klebsiella pneumoniae infections are a major challenge in liver transplantation recipients, particularly due to carbapenem-resistant strains. Effective management requires addressing key risk factors, including pre-transplant colonization and immune dysregulation. Advanced diagnostics like genomic profiling and resistome analysis can enhance understanding of resistance and virulence mechanisms. Optimizing treatment regimens, such as polymyxin B and ceftazidime/avibactam, and developing novel therapeutics targeting specific resistance mechanisms are critical. Routine surveillance and international collaboration can further improve infection control strategies, ensuring better outcomes for this vulnerable population. Integrating microbiology, immunology, and pharmacology advances is essential for transforming liver transplantation infection care.