GASTROENTEROLOGY ARTICLE OF THE WEEK
March 9, 2006
Kusne S, Blair JE. Viral and fungal infections after liver transplantation – Part II. Liver Transpl 2006;12:2-11
1. Risk factors for post transplant fungal infections include
a. Renal insufficiency
b. retransplantation
c. prolonged surgical time
d. infection with CMV
e. infection with hepatitis B virus
2. CMV in the post-transplant setting:
a. May present as leukopenia and thrombocytopenia in the post-transplant patient
b. CMV detected on urine in the post-transplant patient is indicative of CMV disease
c. Liver transplant recipients who are CMV Ab (-) and receive an organ from a CMV (-) donor are not at risk for CMV disease
d. oral acyclovir is as effective as gancyclovir in prophylaxis
e. CMV infection increases the risk of chronic rejection
True or False
3. A liver transplant patient who is exposed to varicella must receive varicella zoster immunoglobulin
4. After liver transplantation, all patients are treated with acyclovir to prevent CMV infection
5. In most adults, post transplant EBV infection represents reactivation of prior disease
6. HHV-6 (human herpes virus 6) can cause a syndrome similar to CMV, diagnosis is difficult and the treatment is the same as for CMV
7. Post transplant lymphoproliferative disease (PTLD) is related to the negative effects of immunosupressants on T cells, allowing EBV infected B-cells to proliferate out of control
8. PTLD that develops more than one year post transplant is usually not associated with EBV infection
9. Cryptococcus is the most common cause of meningitis in the post transplant patient
10. The initial treatment of PTLD is radiation and anti-B cell therapy (Rituximab).
11. HHV-8 can be a cause of Kaposis sarcoma in post-transplant patients.
12. Candida and aspergillus are the two most common types of post-transplant fungal infections.
13. After transplantation, all patients should be placed on antifungal prophylaxis to reduce mortality.