Biliary candida infection after liver transplantation

Aims: Infectious complications after liver transplantation (LT) are a main cause of morbidity and mortality. Biliary complications are observed in approximately 15 to 20 percent of recipients and cholangitis in addition may complicate biliary leckage or stenosis. In this prospective study, we evaluated the rate of bacterial and fungal infections in bile samples obtained from patients after LT during ERC, compared to non-transplanted patients.

Patients and Methods: In 153 patients a total of 200 ERCs was performed (LT n=62, PSC n=29, Cholelithiasis n=38, malignant obstruction n=40, others n=31). Bile specimen was collected immediately after cannulation of the papilla. Microbiological analysis was performed according to standard procedures. In 57% of all ERCs an intervention (sphincterotomy, endoprosthesis, stent, dilation, stone removal) was required.

Results: Of 200 samples obtained 179 were available for complete analysis, 124 (62%) cultures were tested positive and 55 (27,5%) were sterile. Details of the microbiological analysis are shwon in Table 1.

Frequency of candida species and enteric bacteria in bile was significantly higher in patients after LT and patients with malignant biliary obstruction compared to the other groups (p<0.05). Positive cultures for candida were associated with low levels of leukocyte counts in serum (p<0.05) and not related to the bilirubin-level.

Conclusion: As the rate biliary infection was not related to the grade of cholestasis in either chronic or acute disease, the significantly higher rates of bacterial and candida infections in patients after liver transplantation and in patients with malignant biliary obstruction may be due to immunosuppressive treatment and immuno-compromised situation, respectively. Strategies for prevention of fungal cholangitis should be evaluated.

Table 1

Frequency (%)	LT	PSC	Cholelithiasis	Malignant Obstruction	Others
Candida	26	11	6	38	11
Low-grade pathogens	27	19	30	33	15
Enteric bacteria	72	34	24	61	50
Sterile	14	46	54	19	35