Selective bowel decontamination in elective liver transplantation: no improvement in endotoxaemia, initial graft function and post-operative morbidity.
Peri-operative endotoxaemia during liver transplantation has been linked to compromised graft function and infection. Selective decontamination of the digestive tract (SDD) could prevent endotoxaemia by eradicating Gram-negative bacteria from the intestine. In a randomized placebo controlled study we investigated the effects of endotoxaemia and the efficacy of SDD to prevent its occurrence. Thirty-one patients undergoing elective orthotopic liver transplantation received either SDD ( n=15) or placebo ( n=16), which was started at least 7 days before transplantation. Endotoxin levels were measured in blood peroperatively. Patients were scored daily for signs of liver dysfunction and infection. Endotoxaemia was neither associated with initial poor function nor any routine liver function test. Infections were more prominent in patients without endotoxaemia. SDD did not prevent endotoxaemia. Endotoxaemia does not affect post-operative graft function or the incidence of post-operative infections. SDD cannot prevent peri-operative endotoxaemia. Translocation of endotoxin may not be relevant in liver transplantation.
Department of Surgery, P.O. Box 30,001, 9700 RB Groningen, The Netherlands.
John K
JK
Maring
Jan H
JH
Zwaveling
Ids J
IJ
Klompmaker
Jan
J
van der Meer
Maarten J H
MJ
Slooff
D000328:Adult; D004064:Digestive System / Q000382:microbiology*; D019446:Endotoxemia / Q000453:epidemiology*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D010919:Placebos; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome
D010919:Placebos