Bacterial Infection as a Complication of Liver Transplantation: Epidemiology and Risk Factors

George, Donna L.; Arnow, Paul M.; Fox, Amy; Baker, Alfred L.; Thistlethwaite, J. Richard; Emond, Jean C.; Whitington, Peter F.; Broelsch, Christoph E.

doi:10.1093/clinids/13.3.387

Cited by 194 publications

(138 citation statements)

References 34 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…Otherwise, cholangitis (23 YO), septicemia (19 %), and pneumonia (15 %) were the predominant bacterial infections. These findings are in agreement with those of other studies showing incidences of 3 %-lo %, 15 Y0-35 %, and 7 %-I5 %, respectively [4,8,10,15,17,25,26,37,38].…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Barkholt

Andersson

Ericzon

et al. 1997

Transplant International

View full text Add to dashboard Cite

Stool cultures obtained before liver transplantation are useful for choice of perioperative anti biotic prophylaxisAbstract Bacterial infections, especially cholangitis, are still common complications after liver transplantation (LTx). During recent years, multiresistant enterococci have become a nosocomial problem in transplant units. The present prospective study on 26 patients, including 24 patients with chronic liver disease, demonstrated that enterococci were the predominant micro-organism involved in post-LTx bacterial infections. They were cultured in the feces and in other sites of 10 out of 13 (77 %) patients who underwent extensive examinations. Ampicillin-resistant Enterococcus faecium strains were isolated in urine or feces of 2 of the 13 patients prior to LTx. Similarly, resistance to ampicillin and gentamicin, the empirically used antibiotics for patients with fever of unknown origin, was found in E. faecium strains in 3 and 2 patients, respectively. Moreover, multiresistant E. faecium and E. faecalis strains were demonstrated in 46 % of the patients in the postoperative period (3 months). However, no vancomycin-resistant enterococci were isolated. The use of antibiotics within 4 months prior to LTx significantly increased the risk of developing ampicillin-resistant bacteria at the time of LTx and of infections with bacteria of enteric origin after LTx ( P = 0.03 and 0.01, respectively). We conclude that stool and urine cultures performed prior to LTX may be useful for selecting prophylactic antibiotic regimens.

show abstract

Section: Discussionsupporting

confidence: 93%

“…Approximately two-thirds of all liver recipients had at least one episode of bacterial infections during the first 3 months after LTx [4,8,15,17,26,37,38]. The high incidence of asymptomatic UTIs may be explained by bacterial colonization or contamination.…”

Section: Discussionmentioning

confidence: 99%

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Barkholt

Andersson

Ericzon

et al. 1997

Transplant International

View full text Add to dashboard Cite

show abstract

“…Several studies show that both postoperative infection and mortality strongly correlate with the number of blood components transfused intraoperatively. [19][20][21][22][23] During OLT, the anesthesiologist should follow specific transfusion regimes that take into account the pathophysiological changes in cirrhotic patients as well as the different stages of the surgical procedure. Because the donor graft will not be able to fulfill normal hepatic synthesis and clearance functions immediately after reperfusion, we believe that transfusion of FFP should be prefered to that of albumin or other colloid solutions for intraoperative volume replacement.…”

confidence: 99%

Coagulation techniques are not important in directing blood product transfusion during liver transplantation

Reyle-Hahn

Rossaint

1997

Liver Transpl

View full text Add to dashboard Cite

Preoperative acquired clotting parameters such as prothrombin time, activated partial thromboplastin time, antithrombin III, platelet concentration, and fibrinogen show coagulopathy caused by insufficiency of the diseased liver. Intraoperative determination of clotting factors or parameters is not helpful to direct intraoperative transfusion of blood, blood components, or platelets because transfusions performed solely for correction of clotting data do not correlate with the real intraoperative requirements and increase the costs of orthotopic liver transplantation. However, the use of antihyperfibrinolytic drugs seems to reduce intraoperative blood loss. Patients with cirrhotic disorders caused by portalvenous hypertension show extensive collaterals and increased intravascular blood volume. Thus it is plausible that especially overcorrection of blood loss during the surgical preparation in the preanhepatic phase of the operation results in extensive blood loss. Therefore, to avoid blood loss we attempt to keep volume substitution to a minimum during the preanhepatic phase of the operation. In contrast, during the anhepatic and postanhepatic phases we attempt to reestablish normovolemia by transfusing red packed blood cells and fresh-frozen plasma. Strictly confined use of blood products in the preanhepatic phase, followed by later correction of intravascular blood volume, may reduce intraoperative blood loss; it also seems to ensure adequate substitution of clotting factors.

show abstract

“…13,14 However, only the former option is usually performed in children because of the small size of their bile ducts or because of requirements associated with technical variants of LTx (eg, split, reduced, and living donor organs). A prolonged operative time (Ͼ12 hours) during the transplant has been associated with an increased risk of infection 13,15 and is likely a surrogate marker for the technical difficulty of the surgery. Intraoperative events, such as contamination of the operative field, also predispose to postoperative infections.…”

Section: Intraoperative Factorsmentioning

confidence: 99%

“…Of particular concern is the use of anti-lymphocyte preparations, especially OKT3. 6,13,15 Newer anti-lymphocyte antibodies (eg, Thymoglobulin ® ) are also likely to be associated with an increased risk of infection.…”

Section: Posttransplant Factorsmentioning

confidence: 99%

Immunizations and infectious diseases in pediatric liver transplantation

Halasa

Green

2008

Liver Transpl

View full text Add to dashboard Cite

Bacterial Infection as a Complication of Liver Transplantation: Epidemiology and Risk Factors

Cited by 194 publications

References 34 publications

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Stool cultures obtained before liver transplantation are useful for choice of perioperative antibiotic prophylaxis

Coagulation techniques are not important in directing blood product transfusion during liver transplantation

Immunizations and infectious diseases in pediatric liver transplantation

Contact Info

Product

Resources

About