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Management and Outcome of Liver Abscesses After Liver Transplantation

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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.

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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

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Author information

Authors and Affiliations

  1. Unit of HPB Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Department of Surgery, Faculty of Medicine, Complutense University, 4ª Planta. Ctra Andalucía Km 5,4, 28041, Madrid, Spain

    Iago Justo, Carlos Jiménez-Romero, Alejandro Manrique, Oscar Caso, Jorge Calvo, Felix Cambra & Alberto Marcacuzco

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  1. Iago Justo
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  2. Carlos Jiménez-Romero
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  3. Alejandro Manrique
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  4. Oscar Caso
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  5. Jorge Calvo
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  6. Felix Cambra
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  7. Alberto Marcacuzco
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Contributions

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.

Corresponding author

Correspondence to Iago Justo.

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The authors of this manuscript have no conflicts of interest.

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Justo, I., Jiménez-Romero, C., Manrique, A. et al. Management and Outcome of Liver Abscesses After Liver Transplantation. World J Surg 42, 3341–3349 (2018). https://doi.org/10.1007/s00268-018-4622-x

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  • DOI: https://doi.org/10.1007/s00268-018-4622-x

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