Pneumonia occurs in 8–23% of patients after liver transplantation and contributes considerably to their morbidity and mortality. With the increasing acuity of liver transplantation patients in the current era, pneumonias, particularly ventilator-associated pneumonias, and multidrug-resistant pathogens, are of growing concern.
Postliver transplantation pneumonia cause varies with the timing of infection. In the early period (<1 month postliver transplantation), nosocomial pneumonias, including ventilator-associated pneumonias and multidrug-resistant species are most common. During the intermediate period (1–6 months postliver transplantation), opportunistic infections predominate as intensive immunosuppression persists. In the late period (>6 months postliver transplantation), community-acquired bacterial and viral pneumonias arise, as immunosuppression is reduced. Numerous risk factors have been implicated in postliver transplantation pneumonias. Prevention is aimed at reducing bacterial colonization, preventing aspiration events, and utilizing surveillance and targeted antibiotics. Novel studies have also shown reduced risk of infection with personalized immunosuppression regimens guided by an immune function assay.
The etiologic patterns, risk factors, and preventive measures for postliver transplantation pneumonia must be understood to minimize patient exposure to modifiable risks and optimize recipient status in the perioperative period. Prevention is multifaceted and may be enhanced by personalization of immune therapy based on predisposition to infection and graft rejection.
aDepartment of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles
bVeterans Affairs/Robert Wood Johnson Clinical Scholars Program, West Los Angeles VA Health Services Research and Development
cDivision of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
Correspondence to Fady M. Kaldas, MD, 757 Westwood Plaza, Suite 8501, Los Angeles, CA 90095, USA. Tel: +1 310 825 1037; e-mail: email@example.com