Table 3.

Risk Factors and Chronology of Possible Infectious Causes of Elevated Liver Tests After Transplantation.

	Salient features	Infections and possible agents
<1 month	Nosocomial pathogens Donor derived infections. Latent or active infections of the recipient. Typical signs of infections such as fever, and leucocytosis are dampened due to immunosuppression	Bacterial infections predominate There is shift towards infection with multidrug resistant organisms. Non-albicans Candida species more common among the fungal infections. Common infection sites include: •Surgical site/wound •intraabdominal abscesses •Vascular lines and urinary catheters •Lower respiratory tract C. difficile colitis
1–6 months	Opportunistic infections more common Reactivation of latent or transmitted infections can occur.	Opportunistic infections •Cytomegalovirus •Epstein bar virus •Herpes viruses •Tuberculosis •Toxoplasma •Cryptococcus •Pneumocystis carinii pneumonia Hepatitis B and C (reactivations > de novo) Fungal infections: increasing incidence of non-albicans Candida species and Aspergillus
>6 months	Reactivation of latent/transmitted infections can also occur Opportunistic infections can occur in recipients with poor graft dysfunction and multiple rejection episodes.	Community acquired infections Epstein bar virus related post-transplant lymphoproliferative disease Fungal infections: Candidaspp, Aspergillus Viral hepatitis A, E
Risk factors for infections in the post-transplant period
•Prolonged operation time or re-operation •Bilio-enteric anastomosis •Recipient disease severity and intensive care unit stay before LT •Recipient bacterial/fungal colonization •Need of renal replacement therapy •Donor intensive care unit stay •Net state of immunosuppression •Repeat rejection episodes- need of steroid boluses and higher net immunosuppression. •Repeated hospitalizations •Cytomegalovirus seronegative recipient and positive donor.

LT, Liver transplantation.