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Las infecciones son la causa más importante de morbimortalidad en los pacientes trasplantados. Aparecen en tres momentos diferentes tras el trasplante dependiendo de factores quirúrgicos, el nivel de inmunosupresión, la exposición ambiental y el tipo de profilaxis utilizada. Las infecciones bacterianas surgen sobre todo en los primeros 2 meses y pueden hacerlo como bacteriemia, infección de la herida quirúrgica, infección intraabdominal o neumonía. La tuberculosis en el paciente trasplantado tiene una presentación más agresiva que en el paciente inmunocompetente y además su manejo se ve dificultado por la interacción farmacológica entre los fármacos tuberculostáticos y los inmunosupresores. Los virus producen infección de manera directa en estos pacientes pero además algunos de ellos, el citomegalovirus y el herpesvirus humano 6, son inmunomoduladores y pueden facilitar otras infecciones y el rechazo del injerto. El uso de técnicas de reacción en cadena de la polimerasa y antigenemia ha hecho posible un diagnóstico más precoz de la infección por citomegalovirus y la implantación de medidas profilácticas. Las infecciones fúngicas siguen presentando una alta mortalidad a pesar de las nuevas técnicas diagnósticas y los nuevos fármacos antifúngicos.
Palabras clave:
Trasplante hepático
Infección fúngica profunda
Citomegalovirus
Infection is the main cause of morbidity and mortality in liver transplant patients. Infections appear in three different periods following transplantation and are related to surgical factors, the degree of immunosuppression, environmental exposure and the type of prophylaxis used. Bacterial infections occur in the first two months after transplantation as bacteremia, surgical wound and intra-abdominal infection, or pneumonia. Tuberculosis in the liver transplant recipient is more aggressive than in immunocompetent persons. Viruses produce direct infection in these patients; moreover, some viruses (e.g., cytomegalovirus and human herpes virus 6) are immunomodulators and can facilitate other infections and graft rejection. Polymerase chain reaction and antigenemia techniques have made possible prompt diagnosis of cytomegalovirus infection and the implementation of prophylactic strategies. Fungal infections still have a high associated mortality rate, despite new diagnostic techniques and new antifungal drugs.
Key words:
Liver transplant
Deep fungal infection
Cytomegalovirus
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