Infectious complications in liver transplant recipients

Infectious complications after liver transplantation are common and may be life-threatening in the short and even long terms. The risk is related to the underlying endstage liver disease, major abdominal surgery, and immunosuppressive therapy administered in the postoperative period and further for the whole patient's life. Bacterial infections are dominated by intra-abdominal infections, which mostly start by biliary and vascular surgical complications as well as respiratory and bloodstream infections, especially during the first six months. The risk of invasive fungal infection is particularly high. Targeted or universal prophylaxis or preemptive measures have significantly reduced the risk of several infections including Candida, P. jirovecii, and cytomegalovirus infections. In contrast, diagnosis of invasive aspergillosis remains difficult and its subsequent mortality high. In hepatitis C virus (HCV) ribonucleic acid carriers, the systematic HCV recurrence on the graft after liver transplantation in the absence of prior therapy is associated with cirrhosis development and long-term poor outcome. It represents the most common long-term infectious complication. Efficiency of the available treatments is limited due to the low rate of sustained viral response and poor tolerance. The perspective of direct HCV antivirals including inhibitors of protease, polymerase, and other non-structural HCV proteins represents a major step in the treatment of HCV recurrence after liver transplantation.