Hernandez Maria Del Pilar, Martin Paul, Simkins Jacques
Dr Hernandez is an assistant professor of medicine and Dr Martin is a professor of medicine in the Division of Hepatology at the University of Miami Miller School of Medicine in Miami, Florida. Dr Simkins is an assistant professor of medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine.
Gastroenterol Hepatol (N Y). 2015 Nov;11(11):741-53.
Orthotopic liver transplantation (OLT) is the standard of care for patients with decompensated cirrhosis and for patients with hepatocellular carcinoma. More than 6000 liver transplants are performed annually in the United States. High patient and graft survival rates have been achieved in great part due to the availability of potent immunosuppressive agents. Systemic immunosuppression has rendered the liver recipient susceptible to de novo infections as well as reactivation of preexisting latent infections. Infections occurring during the first month post-OLT are usually nosocomial, donor-derived, or the result of a perioperative complication. The development of opportunistic infections (OIs) such as Aspergillus and the reactivation of latent infections such as Mycobacterium tuberculosis are more frequent 1 to 6 months posttransplant, when the net state of immunosuppression is the highest. Immunosuppressive therapy is tapered 6 to 12 months post-OLT; therefore, infections occurring during that time period and afterward generally resemble those of the general population. Screening strategies applied to determine the risk of an infection after transplantation and the use of prophylactic antimicrobial therapy have reduced the incidence of OIs after OLT. This article will review the various causes of infection post-OLT and the therapies used to manage complications.
原位肝移植（OLT）是失代偿期肝硬化患者和肝细胞癌患者的标准治疗方法。美国每年进行超过6000例肝移植手术。由于强效免疫抑制剂的可用性，患者和移植物的存活率在很大程度上得到了提高。全身免疫抑制使肝移植受者易发生新发感染以及既往潜伏感染的重新激活。OLT术后第一个月内发生的感染通常是医院获得性、供体来源的或围手术期并发症的结果。移植后1至6个月，当免疫抑制的净状态最高时，曲霉菌等机会性感染（OIs）的发生以及结核分枝杆菌等潜伏感染的重新激活更为频繁。OLT术后6至12个月逐渐减少免疫抑制治疗；因此，在此期间及之后发生的感染通常与普通人群的感染相似。用于确定移植后感染风险的筛查策略以及预防性抗菌治疗的使用降低了OLT后OIs的发生率。本文将综述OLT后感染的各种原因以及用于处理并发症的治疗方法。
