Infected bilomas in liver transplant recipients, incidence, risk factors and implications for prevention.
Bilomas, infected hepatic fluid collections, are a frequent complication of liver transplantation. We report a case-control cohort study to determine the incidence and microbiologic profile of bilomas and risk factors for biloma formation in 492 patients undergoing liver transplantation from 1994 to 2001. Fifty-seven patients (11.5%) developed one or more bilomas; 95% in the first year post-transplantation. The most common initial infecting pathogens were enterococci (37%), one-half resistant to vancomycin (VRE); coagulase-negative staphylococci (26%); and Candida species (26%). Infection by coagulase-negative staphylococci was strongly associated with the presence of a T-tube (OR 9.60, p=0.02). In stepwise logistic regression multivariable analyses, hepatic artery thrombosis (OR 90.9, p<0.0001), hepatic artery stenosis (OR 13.2, p<0.0001) and Roux-en-Y choledochojejunostomy (OR 5.8, p=0.03) were independent risk factors for biloma formation; ursodeoxycholic acid use was highly protective (OR 0.1, p=0.002). Strategies to prevent biloma formation must focus on measures to prevent hepatic artery thrombosis and colonization of liver transplant patients by multiresistant nosocomial pathogens. T-tube drainage post-transplantation bears reassessment. The protective effect of ursodeoxycholic acid found in this study warrants confirmation in a prospective multicenter, randomized trial.
Said
Adnan
A
Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
Safdar
Nasia
N
Lucey
Michael R
MR
Knechtle
Stuart J
SJ
D'Alessandro
Anthony
A
Musat
Alexandru
A
Pirsch
John
J
Kalayoglu
Munci
M
Maki
Dennis G
DG
D002177:Candidiasis / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D003251:Constriction, Pathologic; D024881:Drug Resistance, Bacterial; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000378:metabolism; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014640:Vancomycin / Q000494:pharmacology
D014640:Vancomycin