Year : 2016  |  Volume : 10  |  Issue : 2  |  Page : 147-154

Delayed-onset chest infections in liver transplant recipients: a prospective study

1 Department of Chest Medicine, Gastrointestinal Surgical Center Faculty of Medicine, Mansoura University, Mansoura, Egypt
2 Department of Anesthesia and Intensive Care, Gastrointestinal Surgical Center Faculty of Medicine, Mansoura University, Mansoura, Egypt
3 Department of Medical Microbiology and Immunology, Gastrointestinal Surgical Center Faculty of Medicine, Mansoura University, Mansoura, Egypt

Correspondence Address:
Rehab Ahmad Elmorsey
Department of Chest Medicine, Mansoura University Hospitals, Faculty of Medicine, Mansoura University, Daqahlia, 35516
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1687-8426.184362

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Objectives: Liver transplant recipients are liable to many infectious and noninfectious chest complications, especially post-transplant pneumonia, which is the major cause of morbidity and mortality. Many studies have evaluated post-liver-transplant early-onset pneumonia. The aim of this study was to evaluate delayed-onset chest infections following liver transplantation. Materials and methods: This prospective study was carried out on 50 adult living donor liver transplant recipients (mean age: 49.68±6.4 years; 44 men and six women). Delayed-onset chest infections that developed after the first month after transplant until the end of the first year were evaluated to determine their frequency, causative microorganisms, associated risk factors, and effect on mortality. Results: Delayed-onset chest infections were detected in six patients (12%) and were complicated, with a 50% mortality rate. The causative organisms were carbapenemase-producing Enterobacteriaceae spp., multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Only one case was diagnosed as pleural tuberculosis in the late period of 6–12 months post liver transplantation. The mortality rate was significantly higher in patients who developed chest infections than among those who developed graft- related complications (P=0.009). Persistent moderate-to-large post-transplant transudative pleural effusion and the use of tacrolimus were associated with increased frequency of post-transplant delayed-onset chest infections (P=0.029 and 0.021, respectively). Conclusion: Despite the relatively low incidence of post-transplant delayed-onset pulmonary infections, they are a major cause of morbidity and mortality in liver transplant recipients. Tuberculosis should be considered as a cause of post-transplant delayed-onset chest infections.

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