Indian Journal of Critical Care Medicine Medknow Publications on behalf of the Indian Society of Critical Care Medicine ISSN: 0972-5229 EISSN: 1998-359x Vol. 14, Num. 2, 2010, pp. 106-107

Indian Journal of Critical Care Medicine, Vol. 14, No. 2, April-June, 2010, pp. 106-107

Letter to the Editor

Critical care issues in liver transplantation

Luis Ignacio Gonzalez-Granado

Immunodeficiencies Unit, Hospital 12 octubre. Carretera Andalucia km 5,400. Postal Code: 28041. Madrid. Spain
Correspondence Address: Dr. Luis Ignacio Gonzalez-Granado, Immunodeficiencies Unit. Hospital 12 octubre. Carretera Andalucia km 5,400. Postal Code: 28041. Madrid. Spain, nachgonzalez@gmail.com

Code Number: cm10023

DOI: 10.4103/0972-5229.68232

Dear Editor,

I read with keen interest the review by Gopal et al. in the journal. ^[1] I am grateful for their great review. However, I would like to make some comments.

First, there are recent reports that demonstrate the superiority of quadruple or triple immunosupression versus traditional approach in terms of efficacy and safety. ^[2] This positive outcome is mainly related to the use of tacrolimus as the cornerstone within the immunosuppressive treatment. ^[3]

Second, in areas where Chagas disease is endemic, with migratory flows, reactivation should be considered when the donor has Latin-American origin, nowadays this complication has been recognized in USA and Europe. ^[4],[5]

Third, the authors missed the important issue that transplant recipients may develop severe infection with Streptococcus pneumoniae, even in the early postransplant period. ^[6] Vaccination has been recommended in heart, renal and liver recipients. Available vaccines are the 23-valent polysaccharide and the hepta- and decavalent protein conjugate. ^[7]

References

1.	Gopal PB, Kapoor D, Raya R, Subrahmanyam M, Juneja D, Sukanya B. Critical care issues in adult liver transplantation. Indian J Crit Care Med 2009;13:113-9.  Back to cited text no. 1  [PUBMED]
2.	Lu AW, Zheng SS, Wu J, Liang TB, Wang WL, Shen Y, et al. Dual, triple, and quadruple oral tacrolimus-based immunosuppression regimens after orthotopic liver transplantation: a randomised comparative study of regimens. Zhonghua Yi Xue Za Zhi 2006;86:3389-92.  Back to cited text no. 2  [PUBMED]
3.	Jonas S, Neuhaus R, Junge G, Klupp J, Theruvat T, Langrehr JM, et al. Primary immunosuppression with tacrolimus after liver transplantation: 12-years follow-up. Int Immunopharmacol 2005;5:125-8  Back to cited text no. 3
4.	Souza FF, Castro-E-Silva O, Marin Neto JA, Sankarankutty AK, Teixeira AC, Martinelli AL, et al. Acute chagasic myocardiopathy after orthotopic liver transplantation with donor and recipient serologically negative for Trypanosoma cruzi: a case report. Transplant Proc 2008;40:875-8  Back to cited text no. 4
5.	D'Albuquerque LA, Gonzalez AM, Filho HL, Copstein JL, Larrea FI, Mansero JM, et al. Liver transplantation from deceased donors serologically positive for Chagas disease. Am J Transplant 2007;7:680-4.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.	Engelhard D, Cordonnier C, Shaw PJ, Parkalli T, Guenther C, Martino R, et al. Early and late invasive pneumococcal infection following stem cell transplantation: a European Bone Marrow Transplantation survey. Br J Haematol 2002;117:444-50.  Back to cited text no. 6  [PUBMED]
7.	Duchini A, Goss JA, Karpen S, Pockros PJ. Vaccinations for Adult Solid-Organ Transplant Recipients: Current Recommendations and Protocols. Clin Microbiol Rev 2003;16:357-64.  Back to cited text no. 7  [PUBMED]

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