Early-Onset Pneumonia in Recipients of Liver Transplant

Early-onset pneumonia with multidrug-resistant organisms is a major concern for patients who have received a liver transplant, and pre- and intra-operative risk factors influence its development, according to study data presented at The American Association for the Study of Liver Diseases’ The Liver Meeting, held November 8 to 12, 2019 in Boston, Massachusetts.

In an effort to better understand infection risk, etiology, and identification of the pathogens responsible for early-onset multidrug resistant pneumonia in recipients of a liver transplant, 89 patients undergoing liver transplantation were included in the present study. The demographic, pre-, intra- and postoperative data were recorded and microbiologic identification and antibiotic susceptibility tests were performed.

Men comprised 87.6% of the patients receiving liver transplants. The mean age of the study cohort was 40.1 ± 15 years, and the most common indication for transplantation was alcoholic liver disease. Early onset pneumonia, defined per the United States Centers for Disease Control and Prevention as pneumonia occurring within 30 days post-transplant developed in 31 (34.8%) of patients. Among patients with such infection, 25.8% of cases were ventilator-associated, and the mortality rate resulting from early-onset pneumonia was 32.3%.

Of 51 respiratory samples that were sent for culture, 58.8% were positive for a microbial pathogen. The most common bacterial isolates were: Klebsiella pneumoniae (21.6%), Pseudomonas aeruginosa (7.8%), Stenotrophomonas maltophila (7.8%), and Acinetobacter baumanii (5.8%). The most common fungal isolates were Aspergillus spp, followed by Candida auris and Rhizopus spp. Multidrug resistance was common among isolates, however, the identified isolates were most commonly susceptible to colistin and fosfomycin.

Several characteristics also were more frequently observed in patients with early onset pneumonia than in those without. These included, need for noninvasive ventilation (74.2% vs 6.9%; P< .01), mechanical ventilation (48.4% vs 6.9%; P< .01), tracheostomy (19.4%; P< .01), or vasopressor use (71% vs 17.2%; P= .01) or presence of sepsis (74.2% vs 24.1%; P< .01).

The investigators concluded that early-onset pneumonia with multidrug-resistant organisms is a concern for recipients of a liver transplant in the immediate post-transplantation period, with significant mortality and morbidity. They also stated that pre- and intra-operative risk factors can influence development of early onset pneumonia; therefore, knowing the risks and taking essential preventive steps will influence outcomes for transplant recipients.

Reference

Pindi G, Khillan V, Kale P, Pamecha V. Early onset pneumonia in liver transplant recipients: Identifying the risk factors through the haze. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 1138.