**7. Infection prophylaxis**

Prevention of infections is a major problem as they are the leading cause of death following LT [74]. The most common ones in the immediate postoperative period are of bacterial or fungal origin and include bloodstream, catheter related, surgical site, pulmonary, urinary tract, *Clostridium difficile* infections, and intra-abdominal collections. The identification of risk factors and the stratification of patients according to them determine the prophylactic perioperative antimicrobial treatment [75, 76]. Antimicrobial chemoprophylaxis depends on the patient's immune status, intraoperative events, recent or recurrent hospitalization, and donor infections at the time of liver graft procurement while it has been tailored in accordance with the colonization of the patients, recently characterized by a prevalence of multidrug-resistant Gram-negative bacilli [76, 77]. Other recipient-related risk factors are malnutrition, re-operation, acute liver failure, biliary complications, and the existence of postoperative catheters, lines, and drains. Antibiotics right before surgery cover Gram-negative bacteria (*Pseudomonas* sp., *Enterobacter* sp., and *Klebsiella* sp.), Gram-positive organisms (*Staphylococcus aureus*), fungi, and viruses according to the center protocols and their epidemiology*.* Antifungal prophylaxis is administered to higher risk patients determined by factors such as renal dysfunction with a need for RRT, re-transplantation, multiple transfusions, prolonged ICU stay, colonization by *Candida*, and graft rejection incidents with administration of high doses of corticosteroids. In many centers, azoles or liposomal amphotericin are used [76–78]. Siddique et al. reported that the rate of post-transplant infections was 24.5% with no difference between deceased and living donors; however, mortality was higher in bacterial infections in deceased donor recipients [79].

Herpes family viral infections, due to immunosuppression mainly by administration of T-cell-specific agents, are adequately treated with acyclovir. Ganciclovir or valganciclovir is sufficient for CMV seronegative recipients with CMV-seropositive grafts, or after rejection treatment. In case of suspected infection during hospitalization, broad spectrum antimicrobial therapy is administered and reviewed according to cultures results [75].
