Rare infectious complication after living donor liver transplantation

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 postoperative course of liver transplant recipients. It has been well described that MRSA associated bacteremia, pneumonia and surgical site infection are common. But, MRSA infection manifesting as pyogenic spondylodiscitis is very rare. To our knowledge, pyogenic spodylodiscitis 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 HBV related cirrhosis. Immunosuppressive treatment was administered with basiliximab, tacrolimus, corticosteroids and mycophenolate mofetil. He discharged on postoperative the 28th day with uncomplicated course. At one week after discharge the patient was readmitted for abdominal pain and high fever. Bile leakage at the anastomosis site was found by ERCP and managed successfully with endoscopic nasobiliary drainage (ENBD). The culture of drained fluid showed MRSA and he was treated with vancomycin for 4 weeks. These treatment resulted in resolution of the infection. However, one month later the patient presented with severe back pain. At this time, MRI showed massive 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 sequelae. Presently he is followed up and doing well without rejection and other complications.