Survival rates after liver transplantation have significantly improved due to advancements in surgical techniques, perioperative care, and the use of effective immunosuppressive regimens. However, de novo or recurrent viral infections following liver transplantation (LT) remain a major cause of allograft dysfunction and can severely impact graft and patient survival if left untreated. The introduction of potent antiviral therapies has markedly enhanced posttransplant outcomes. Chronic de novo hepatitis E virus (HEV) infection is now increasingly recognized as a contributor to liver graft dysfunction. Without treatment, chronic HEV infection can progress to liver fibrosis and eventual allograft failure. Similarly, the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) can result in systemic illness posttransplant. In the context of the COVID-19 pandemic, liver transplant recipients are particularly susceptible to SARS-CoV-2 infection. Most affected patients require hospitalization, and mortality among this group is estimated to be around 20%. Timely detection of allograft dysfunction and accurate identification of the underlying viral cause are critical in managing de novo or recurrent posttransplant infections. Adjusting immunosuppressive therapy plays a key role in mitigating allograft injury. Early initiation of high-potency antiviral treatment is essential for achieving viral control or clearance.

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Post–Liver Transplant Viral Infections (Non-hepatotropic)

  • Dinesh Jothimani,
  • Radhika Venugopal

摘要

Survival rates after liver transplantation have significantly improved due to advancements in surgical techniques, perioperative care, and the use of effective immunosuppressive regimens. However, de novo or recurrent viral infections following liver transplantation (LT) remain a major cause of allograft dysfunction and can severely impact graft and patient survival if left untreated. The introduction of potent antiviral therapies has markedly enhanced posttransplant outcomes. Chronic de novo hepatitis E virus (HEV) infection is now increasingly recognized as a contributor to liver graft dysfunction. Without treatment, chronic HEV infection can progress to liver fibrosis and eventual allograft failure. Similarly, the reactivation of cytomegalovirus (CMV) and Epstein-Barr virus (EBV) can result in systemic illness posttransplant. In the context of the COVID-19 pandemic, liver transplant recipients are particularly susceptible to SARS-CoV-2 infection. Most affected patients require hospitalization, and mortality among this group is estimated to be around 20%. Timely detection of allograft dysfunction and accurate identification of the underlying viral cause are critical in managing de novo or recurrent posttransplant infections. Adjusting immunosuppressive therapy plays a key role in mitigating allograft injury. Early initiation of high-potency antiviral treatment is essential for achieving viral control or clearance.