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World J Gastroenterol. May 28, 2014; 20(20): 6211-6220
Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6211
Bacterial infection after liver transplantation
Sang Il Kim
Sang Il Kim, Division of Infectious Disease, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Kim SI solely contributed to this paper.
Correspondence to: Sang Il Kim, MD, Division of Infectious Disease, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea.
Telephone: +82-2-22581242  Fax: +82-2-22581254
Received: October 27, 2013
Revised: January 10, 2014
Accepted: February 17, 2014
Published online: May 28, 2014

Infectious complications are major causes of morbidity and mortality after liver transplantation, despite recent advances in the transplant field. Bacteria, fungi, viruses and parasites can cause infection before and after transplantation. Among them, bacterial infections are predominant during the first two months post-transplantation and affect patient and graft survival. They might cause surgical site infections, including deep intra-abdominal infections, bacteremia, pneumonia, catheter-related infections and urinary tract infections. The risk factors for bacterial infections differ between the periods after transplant, and between centers. Recently, the emergence of multi-drug resistant bacteria is great concern in liver transplant (LT) patients. The instructive data about effects of infections with extended-spectrum beta lactamase producing bacteria, carbapenem-resistant gram-negative bacteria, and glycopeptide-resistant gram-positive bacteria were reported on a center-by-center basis. To prevent post-transplant bacterial infections, proper strategies need to be established based upon center-specific data and evidence from well-controlled studies. This article reviewed the recent epidemiological data, risk factors for each type of infections and important clinical issues in bacterial infection after LT.

Keywords: Liver transplantation, Bacterial infection, Intraabdominal infections, Resistant bacteria

Core tip: Bacterial infections are major causes of morbidity and mortality after liver transplantation. To prevent post-transplant infectious complications, epidemiology, risk factors and clinical characteristics of bacterial infections should be monitored and controlled. Currently, novel threats are arising from multi-drug resistant bacteria and recipients with higher risk for infection are increasing. Despite improved surgical techniques and post-transplant care systems, early diagnosis and appropriate treatment of bacterial infections are vital for successful liver transplantation.