Evaluation of clinical characteristics and outcomes of postoperative ınfections in living liver donors

Abstract

Aim:To analyze developing infections after living donor hepatectomy (LDH) in living liver donors (LLDs).Methods: Demographic and clinical characteristics of 1106 LLDs were retrospectively analyzed in terms of whether postoperative infection development. Therefore, LLDs were divided into two groups: with (n = 190) and without (n = 916) antimicrobial agent use. Results:The median age was 29.5 (min-max: 18-55). A total of 257 (23.2%) infection attacks (min-max: 1-8) was developed in 190 (17.2%) LLDs. The patients with the infection that were longer intensive care unit (ICU) and hospital stays, higher hospital admissions, emergency transplantation, invasive procedures for ERCP, PTC biloma, and abscess drainage, and the presence of relaparatomies and transcystic catheters. Infection attacks are derived from a 58.3% hepatobiliary system, 13.2% urinary system, 6.6% surgical site, and 5.8% respiratory system. The most common onset symptoms were fever, abdominal pain, nausea, and vomiting. A total of 125 positive results was detected from 77 patients with culture positivity. The most detected microorganisms from the cultures taken are Extended-Spectrum β-lactamases (ESBL) producing Klebsiella pneumonia (16.8%) and Escherichia coli (16%), Methicillin-Resistant Staphylococcus aureus [(MRSA) (9.6%)], Methicillin-susceptible S aureus [(MSSA) (9.6%)], and Pseudomonas aeruginosa (8.8%), respectively. The average number of ICU hospitalization days was 3 ± 2 (min 1-max 30, IQR:1) and hospitalization days was 14 ± 12 (min 3-max 138, IQR: 8). All infection attacks were successfully treated. No patients died because of infection or another surgical complication. Conclusion:Infections commonly observed infected biloma, cholangitis, and abscess arising from the biliary system and other nosocomial infections are the feared complications in LLDs. These infections should be managed multidisciplinary without delay and carefully.

When is it safe for the liver donor to be discharged home and prevent unnecessary re‐hospitalizations? – A systematic review of the literature and expert panel recommendations

“…The critical outcomes selected by the expert's panel group were complicationsrate and bilirubin or PT/INR peak or value at discharge. Among 57 studies, only 28 studies 20,[23][24][25]28,33,35,36,38,[43][44][45][46][47]52,56,[58][59][60][61][62]64,[68][69][70][71][72][73] were included in qualitative analysis for critical outcomes.…”

“…Some 103 full‐text articles were excluded for the following reason: recipients only ( n = 21); not relevant ( n = 55); opinion ( n = 10); case study ( n = 1); pediatric LD ( n = 7); not English ( n = 2); systematic/Lit review ( n = 4); published abstract ( n = 3); duplicates (= 1). In qualitative synthesis, 57 studies were included 18–73 . Studies with less than 50 patients and published more than 10 years ( n = 28) were also excluded of the GRADE.…”

“…After review of the titles and abstracts, 57 studies were selected 18–73 . The main features of the studies are reported in Table 1.…”

“…Of the studies selected, 29 were published before 2011, 18,19,21,22,26,27,[29][30][31][32]34,[38][39][40][41][42][48][49][50][51][53][54][55]57,63,65,66,67 and the other 28 since 2011. 20,[23][24][25]28,33,[35][36][37][43][44][45][46][47]52,56,[58][59][60][61][62]64,[68][69][70]…”

“…The rate of re-hospitalization was reported in 12 studies. 24,26,29,[31][32][33][34][35]37,52,53,74 Among 57 studies, 7 21,29,37,38,44,54,56 and 37 22,[27][28][29][30][31][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]53,54,56,57,[61][62][63][64][65][66][67]…”