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Kornasiewicz O, Hołówko W, Grąt M, Gorski Z, Dudek K, Raszeja-Wyszomirska J, Krawczyk M. Hepatic abscess: a rare complication after liver transplant. Clin Transplant 2016; 30:1230-1235. [PMID: 27409774 DOI: 10.1111/ctr.12807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Oskar Kornasiewicz
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
| | - Wacław Hołówko
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
| | - Michał Grąt
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
| | - Zuzanna Gorski
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
| | - Krzysztof Dudek
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
| | | | - Marek Krawczyk
- Department of General, Transplant and Liver Surgery; Medical University of Warsaw; Warsaw Poland
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El-Badrawy MK, Ali REM, Yassen AM, Elela MAA, Elmorsey RA. Delayed-onset chest infections in liver transplant recipients: a prospective study. Egypt J Bronchol 2016. [DOI: 10.4103/1687-8426.184362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Zhang ML, Xu J, Zhang W, Liu XY, Zhang M, Wang WL, Zheng SS. Microbial epidemiology and risk factors of infections in recipients after DCD liver transplantation. Int J Clin Pract 2016; 70 Suppl 185:17-21. [PMID: 27198000 DOI: 10.1111/ijcp.12812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM Infection is a major cause of increased mortality after a liver transplant (LT). This study sought to identify the incidence, prevalence and risk factors of microbial infection for recipients who underwent LT using grafts from donors after cardiac death (DCD). METHODS We retrospectively analysed the frequency and characteristics of post-transplantation infections in 236 recipients who underwent DCD LT between 1 January 2010 and 31 December 2014 in our centre and evaluated the risk factors of post-transplantation infection. RESULTS Overall, 162 recipients acquired at least one type of infection during hospitalisation after LT, and the morbidity rate was 68.6%. Moreover, 19 of the 236 recipients died, with an overall mortality rate of 8.1%. In total, 752 pathogens were isolated. Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 26.1% (196), 58.2% (438) and 15.7% (118) of the pathogens, respectively. Kaplan-Meier curves of 1-year survival showed that recipients with infection had a significantly lower cumulative survival rate compared with those without infection (83.2% vs. 90.6%, p < 0.05). Multivariate analysis revealed that age > 60 years (p = 0.010) and severe hepatitis (p = 0.036) were independent risk factors for infection during hospitalisation after LT. CONCLUSION Infection is a common complication after a DCD-LT that could impair 1-year survival. We suggest physicians pay more attention to the infection of recipients post-LT, especially those recipients greater than 60 years of age and those who suffered from severe hepatitis.
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Affiliation(s)
- M-L Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - J Xu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - W Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - X-Y Liu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - M Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - W-L Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
| | - S-S Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Hangzhou, China
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Kierzkowska M, Majewska A, Sawicka-Grzelak A, Mlynarczyk A, Chmura A, Durlik M, Deborska-Materkowska D, Paczek L, Mlynarczyk G. Specific character of anaerobic bacterial infections in patients treated in transplantation wards at one of the clinical hospitals in Warsaw. Transplant Proc 2015; 46:2586-8. [PMID: 25380872 DOI: 10.1016/j.transproceed.2014.08.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacterial infections, due to the possibility of micro-organism translocation from their physiological habitat. Infectious complications may occur both in the early and late post-transplantation periods. The purpose of this study was to evaluate the proportion as well as susceptibility profiles of obligatory anaerobes in the etiology of infections in patients hospitalized at transplantation wards of a large clinical hospital in Warsaw. A total of 104 strains of obligatory anaerobes derived from patients hospitalized in two transplantation clinics at a clinical hospital in Warsaw were evaluated. The strains were isolated from 87 clinical samples collected from 84 patients of two transplantation wards between 2007 and 2012. A total of 104 obligatory anaerobic bacterial strains were isolated and identified, with Gram-positive and Gram-negative bacteria constituting 60.6% and 39.4% of the isolates, respectively. Almost exclusively non-spore-forming anaerobes were detected in evaluated samples. The present study showed all isolated Gram-positive bacteria to be susceptible to ß-lactam antibiotics. Metronidazole-resistant bacteria were found among the genera Propionibacterium and Actinomyces. All Gram-negative rods were susceptible to imipenem and metronidazole. Among them, Bacteroides spp. and Parabacteroides distasonis showed resistance to penicillin G (100%). Because of their pathogenicity and altered antibiotic susceptibility profiles, the bacteria of the genera Bacteroides and Parabacteroides are of greatest clinical importance. Approximately 25% of isolates exhibit also resistance to clindamycin. Because of the growing rates of clindamycin resistance, the role of metronidazole in the treatment of Bacteroides spp. is of increasing importance.
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Affiliation(s)
- M Kierzkowska
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Majewska
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Sawicka-Grzelak
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Mlynarczyk
- Department of Dental Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Department of General and Transplantation Surgery, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplant Medicine and Nephrology, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - D Deborska-Materkowska
- Department of Transplant Medicine and Nephrology, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Department of Immunology, Transplantology and Internal Diseases, Transplantology Institute, Medical University of Warsaw, Warsaw, Poland
| | - G Mlynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
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Mukhtar A, Abdelaal A, Hussein M, Dabous H, Fawzy I, Obayah G, Hasanin A, Adel N, Ghaith D, Bahaa M, Abdelaal A, Fathy M, El Meteini M. Infection complications and pattern of bacterial resistance in living-donor liver transplantation: a multicenter epidemiologic study in Egypt. Transplant Proc 2015; 46:1444-7. [PMID: 24935311 DOI: 10.1016/j.transproceed.2014.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/20/2014] [Accepted: 02/27/2014] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Data on the prevalence and pattern of infection after living-donor liver transplantation (LDLT) are scarce in Egypt. We therefore conducted this study to quantify the incidence, risk factors, and pattern of bacterial resistance post-LDLT in 3 hospitals in Egypt. PATIENTS AND METHODS We conducted a retrospective, multicenter study of the medical records of 246 patients who underwent LDLT between January 2006 and April 2011 at 3 transplant centers in Egypt. RESULTS Of 246 patients enrolled in this study, 127 (52%) developed infectious complications after LDLT, with 416 episodes of infection occurring within 3 months of transplantation. Biliary tract infection was the most common, occurring in 169 (40.6%) patients. The rate of infection with Gram-negative bacteria was higher than that of infection with Gram-positive bacteria (310 [74%] vs 87 [21%]; P < .001). Overall, 75% of Gram-negative isolates were multidrug resistant. Significant independent risk factors for infection were portal vein thrombosis (odds ratio, 2.4; P = .037) and biliary complications (odds ratio, 5.4; P < .001). CONCLUSIONS Our data showed a high-resistance pattern of bacterial infection after LDLT in Egypt. Early biliary complications were an independent risk factor for bacterial infection.
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Affiliation(s)
- A Mukhtar
- Department of Anesthesia and Critical Care, Cairo University, Cairo, Egypt.
| | - A Abdelaal
- Department of Anesthesia and Critical Care, Beni Suef University, Egypt
| | - M Hussein
- Department of Anesthesia and Critical Care, Theodor Bilharz Research Institute, Egypt
| | - H Dabous
- Department of Hepatology, Ain Shams University, Cairo, Egypt
| | - I Fawzy
- Department of Hepatology, Ain Shams University, Cairo, Egypt
| | - G Obayah
- Department of Anesthesia and Critical Care, Cairo University, Cairo, Egypt
| | - A Hasanin
- Department of Anesthesia and Critical Care, Cairo University, Cairo, Egypt
| | - N Adel
- Department of Critical Care, Egypt Air Hospital, Egypt
| | - D Ghaith
- Department of Clinical Bacteriology, Cairo University, Cairo, Egypt
| | - M Bahaa
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - A Abdelaal
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - M Fathy
- Department of Surgery, Ain Shams University, Cairo, Egypt
| | - M El Meteini
- Department of Surgery, Ain Shams University, Cairo, Egypt
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Abstract
PURPOSE OF REVIEW The purpose of this study is to provide an overview of bacterial biliary tract infections in liver transplant recipients with a focus on pathogenesis and conservative treatment strategies. RECENT FINDINGS The development of interventional endoscopic and radiologic interventions has improved the outcome of conservative treatments for bile tract strictures and bilomas. However, recent data show an important rise of infections with multidrug-resistant (MDR) pathogens in liver transplant recipients. SUMMARY Both recurrent cholangitis and infected bilomas are bacterial biliary tract infections in liver transplant recipients responsible for significant morbidity and graft loss, which require a multidisciplinary approach. Risk factors for biliary tract strictures and bilomas formation have recently been identified. With the improved outcome of a conservative management including prolonged and/or recurrent antibiotic treatments, the risk of selecting resistant pathogens is increased. There is an urgent need to develop new strategies to reduce the risk of secondary infections by MDR isolates in liver transplant recipients.
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Lin KH, Liu JW, Chen CL, Wang SH, Lin CC, Liu YW, Yong CC, Lin TL, Li WF, Hu TH, Wang CC. Impacts of pretransplant infections on clinical outcomes of patients with acute-on-chronic liver failure who received living-donor liver transplantation. PLoS One 2013; 8:e72893. [PMID: 24023787 PMCID: PMC3759387 DOI: 10.1371/journal.pone.0072893] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 07/14/2013] [Indexed: 02/07/2023] Open
Abstract
Background Liver transplantation is the only therapeutic modality for patients with acute-on chronic liver failure (ACLF). These patients are at high risk for bacterial infections while awaiting transplantation. The aim of this study was to elucidate whether an adequately treated bacterial infection influences the outcomes after transplantation in this patient population. Methodology/Principal Findings 54 recipients (median age, 49.5 years [range, 22–60]) of adult-to-adult living donor liver transplant (LDLT) for ACLF were categorized as those with pretransplant infection (Group 1, n = 34) or without pretransplant infection (Group 2, n = 20) for retrospective analyses. With the exception of a higher male-female ratio (P = 0.046) and longer length of pretransplant hospital stay (P = 0.026) in Group 1, similar demographic, laboratory and clinical features were found in both groups. Patients in Group 1 (totally 42 pretransplant infection episodes) were adequately treated with effective antibiotic(s) before receiving LDLT. All included patients were followed up until one year after transplantation or death. Sixty-one posttransplant infection episodes were found in an overall of 44 ACLF patients (27 in Group 1 vs. 15 in Group 2; P = 0.352). Frequently encountered posttransplant infections were intraabdominal infection, pneumonia, bloodstream infection and urinary tract infection. Two patients died in each group (P = 0.622). No significant difference was found in the length of posttransplant ICU stay, and in one-year survival, graft rejection, and posttransplant infection rate between both groups. The longer overall hospital stay (mean day, 89.0 vs. 65.5, P = 0.024) found in Group 1 resulted from a longer pretransplant hospital stay receiving treatment for pretransplant infection(s) and/or awaiting transplantation. Conclusions These data suggested that an adequately treated pretransplant infection do not pose a significant risk for clinical outcomes including posttransplant fatality in recipients in adult-to-adult LDLT for ACLF.
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Affiliation(s)
- Kuo-Hua Lin
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Jien-Wei Liu
- Division of Infectious-Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Hor Wang
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yueh-Wei Liu
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chee-Chien Yong
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Lung Lin
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Feng Li
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Tsung-Hui Hu
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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