Bacterial Infections

Bacterial infections occur in 33-68% of liver transplants, 21-30% of heart transplants, 54% lung transplants, 35% of pancreas transplants, and 47% of kidney transplants. The types of infections encountered and the bacterial etiologies differ depending on the transplanted organ and the surgical technique used. Below, bacterial infections are reviewed in the context of the transplanted organ.

Liver Transplantation

Overview

The most common bacterial infections following liver transplantation are intra-abdominal and surgical wound infections. Cholangitis, abscesses, and intra-vascular device-related bacteremias are other frequent complications. The main risk factors associated with intra-abdominal infections are prolonged surgical time, high transfusion requirements during surgery, re-operations, early rejection, retransplantation, and CMV infection.

The type of biliary anastomosis influences the risk of post-transplant infections. The choledochostomy is associated with less infection risk because the native sphincter of Oddi is maintained. The presence of a Roux-en-y choledocojejunostomy, required in patients with abnormalities of the extra-hepatic biliary system, is associated with a higher incidence of post-operative cholangitis as well as infection following liver biopsy and cholangiography procedures after transplant. This is likely caused by reflux of intestinal contents and microbial flora into the biliary system.

The specific bacterial etiologies of infection after liver transplantation depend on the gastrointestinal flora of the recipients. In the absence of exposure to antimicrobial agents, the enteric gram-negative bacilli such as coliforms, the Entero-bacteriaceae, and occasionally, Pseudomonas species, are the predominant organisms causing infection, along with enterococci, staphylococci, and the anaerobes. Infections with vancomycin-resistant enterococci (VRE) are a significant problem in some transplant centers.

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