Management and Outcome of Liver Abscesses After Liver Transplantation

  • Iago Justo
  • Carlos Jiménez-Romero
  • Alejandro Manrique
  • Oscar Caso
  • Jorge Calvo
  • Felix Cambra
  • Alberto Marcacuzco
Original Scientific Report
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Abstract

Background

Liver abscess after orthotopic liver transplantation (OLT) is a rare, life-threatening complication. The aim of this study is to analyze the incidence, risk factors, clinical manifestations, treatment and outcomes of liver abscesses after OLT.

Methods

We perform a retrospective review of the patients who developed one or more liver abscesses among a series of 984 patients who underwent OLT between January 2000 and December 2016.

Results

Fourteen patients (1.5%) developed 18 episodes of liver abscesses, and the median time from OLT to the diagnosis of liver abscess was 39.7 months. Major predisposing factors were biliary strictures in 11 patients, hepatic artery thrombosis in 8, re-OLT in 3, choledochojejunostomy in 2, living donor OLT in 2, donor after cardiac death in 1, split liver in 1, and liver biopsy in 1. All patients were managed by intravenous antibiotics; percutaneous drainage was performed in 10 patients, while 2 patients underwent re-OLT. The mortality rate related to liver abscesses was 21.4%. The mean hospital stay was 30 ± 19 days, and during a mean follow-up of 93 ± 78 months, three other patients died.

Conclusions

Liver abscesses must be managed with antibiotic therapy and percutaneous drainage, but when these conservative measures fail (persistent abscess and sepsis), a re-OLT must be performed in order to prevent the high mortality associated with this severe complication.

Abbreviations

ALT

Alanine amino transferase

AST

Aspartate amino transferase

CIT

Cold ischemia time

CMV

Cytomegalovirus

CT

Computed tomography

DCD

Donation after cardiac death

GGT

Gamma glutamyl transferase

HAT

Hepatic artery thrombosis

INR

International standardized ratio

LDH

Lactate dehydrogenase

LDLT

Living donor liver transplantation

MMF

Mycophenolate mofetil

OLT

Orthotopic liver transplantation

ICU

Intensive care unit

MRI

Magnetic resonance

RUQ

Right upper quadrant

WBC

White blood cells

WIT

Warm ischemia time

Notes

Authors’ contribution

IJA and CJ-R participated in research design and wrote the paper, AMM participated in data collection, OC participated in research design and data collection, JCP and FCM participated in the performance of the research, and AM participated in data analysis.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Iago Justo
    • 1
  • Carlos Jiménez-Romero
    • 1
  • Alejandro Manrique
    • 1
  • Oscar Caso
    • 1
  • Jorge Calvo
    • 1
  • Felix Cambra
    • 1
  • Alberto Marcacuzco
    • 1
  1. 1.Unit of HPB Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Department of Surgery, Faculty of MedicineComplutense UniversityMadridSpain

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