Prevention and surveillance of infection after liver transplantation

摘要

Liver transplantation has progressed enormously over the last two decades and is now the treatment of choice for a diverse range of chronic and acute hepatic diseases. Improvements in the prevention, detection, and treatment of opportunistic infection in the liver recipient have contributed to this favorable trend. Careful pretransplant diagnostic procedures may detect active or dormant infections that require therapy before transplant or may direct appropriate posttransplant prophylaxis directed against such pathogens asMycobacterium tuberculosis, cytomegalovirus, and the viral hepatitides. Posttransplant chemoprophylaxis has drastically reduced the incidence ofPneumocystis cariniipneumonitis and significantly modified clinical disease from other pathogens, such as herpes simplex and cytomegalovirus. Surveillance methods for posttransplant infection vary among transplant centers and are principally directed toward the monitoring of viral or fungal infection. Clinical suspicions of hazardous environmental nosocomial threats, such asAspergillusor Legionella, may require periods of intense environmental surveillance. Increases in the prevalence of multiresistant nosocomial bacteria have prompted some centers to do regular surveillance to control rates of cross-transmission and superinfection.