Korean J Transplant.  2022 Nov;36(Supple 1):S14. 10.4285/ATW2022.F-0904.

Rare infectious complication after living donor liver transplantation

• Kim JS
• Lee YN
• Kim WY
• Lee JS
• Kim JS

• KMID: 2535130
• DOI: http://doi.org/10.4285/ATW2022.F-0904

Abstract

Despite the remarkable advances of liver transplantation, infections are still the most common and often life-threatening postoperative complications. Methicillin-resistant Staphylococcus aureus (MRSA) infection frequently complicates the postoper-ative course of liver transplant recipients. It has been well described that MRSA associated bacteremia, pneumonia and sur-gical site infection are common. But, MRSA infection manifesting as pyogenic spondylodiscitis is very rare. To our knowledge, pyogenic spondylodiscitis due to MRSA in lumbar spine after living donor liver transplantation (LDLT) has not been previously reported. Here, we report a 50-year-old man who developed pyogenic spondylodiscitis caused by MRSA after LDLT. Our patient underwent LDLT for hepatitis B virus related cirrhosis. Immunosuppressive treatment was administered with basiliximab, tac-rolimus, corticosteroids and mycophenolate mofetil. He discharged on postoperative the 28th day with uncomplicated course. At 1 week after discharge the patient was readmitted for abdominal pain and high fever. Bile leakage at the bilo-biliary anasto-mosis site was found by endoscopic retrograde cholangiopancreatography and managed successfully with endoscopic naso-biliary drainage. The culture of drained fluid showed MRSA and he was treated with vancomycin for 4 weeks. These treatments resulted in resolution of the infection. However, 1 month later the patient presented with severe back pain. At this time, MRI showed spondylodiscitis of lumbar 2–3 spine and paraspinal abscess formation. Our patient underwent surgical debridement and primary bone graft. MRSA was cultured from the abscess. Postoperatively, the patient received intravenous vancomycin for 2 weeks and revealed complete outcome with no neurological sequalae. Although molecular analysis might be needed to identify the clonality of these strains, we compared the antibiogram of these isolates. Presently he is followed up and doing well without rejection and other complications.