Infectious complications of liver transplantation

Liver transplantation is a life-prolonging procedure for patients with end-stage liver disease (ESLD); however, post-transplant infections remain a leading cause of morbidity and mortality. Infection risk varies over time with issues in the early post-transplant period most commonly being related to the transplant surgery and nosocomial infections. Opportunistic infections become more common between 1 and 12 months post-transplant, owing to the greater burden of immunosuppression. Beyond 12 months, the risk of opportunistic infections wanes as immunosuppression is reduced. Recipients continue to be at risk for community acquired infections and recurrent cholangitis may become a concern in those with chronic allograft dysfunction or recurrent cholestatic liver disease. In this article, we will review an approach to infectious complications in the early, intermediate, and late period following liver transplantation with a focus on the most common infections and those of emerging concern.