title: Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality.
abstract: BACKGROUND
  Infected hepatic fluid collections (bilomas) are a major infectious complication of liver transplantation. Limited data exist on management and outcome of biloma.
  
  
  METHODS
  We report a cohort study of 57 liver transplant recipients with posttransplantation bilomas undertaken to identify the clinical features of biloma, management strategies, and outcome.
  
  
  RESULTS
  Fever (44%) and abdominal pain (40%) were the most common presenting symptoms, but one-third of patients were asymptomatic; 79% had elevated hepatic enzyme levels. Patients without hepatic artery thrombosis (HAT) had the highest rates of resolution with percutaneous drainage and anti-infective therapy (64%). Retransplantation was necessary in 64% of patients with HAT and biloma. Independent predictors of resolution with nonsurgical therapy were absence of HAT (odds ratio [OR] 7.69; P=.01) and absence of Candida (OR, 9.09; P=.02) or enterococcal infection (OR, 7.69; P=.03). Patients with bilomas had significantly greater mortality (Cox proportional hazard ratio [HR], 2.38; P=.008, by log rank test) and graft loss (HR, 4.31; P<.0001). Predictors of mortality by multivariable analysis included renal insufficiency (OR, 12.51; P=.02) or infection with Candida species (OR, 4.93; P=.03) or gram-negative bacilli (OR, 9.12; P=.01).
  
  
  CONCLUSIONS
  Posttransplantation biloma should be suspected in patients with fever or abdominal pain or abnormalities of hepatic enzymes, and it can be confirmed by computerized tomography and radiographically guided aspiration. Bilomas are most likely to be successfully treated nonsurgically in patients without HAT and without Candida or enterococcus infection.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, WI, USA.
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
authors.forename: Adnan
authors.initials: A
authors.lastname: Said
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lucey
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Knechtle
authors.forename: Anthony
authors.initials: A
authors.lastname: D'Alessandro
authors.forename: Alexandru
authors.initials: A
authors.lastname: Musat
authors.forename: John
authors.initials: J
authors.lastname: Pirsch
authors.forename: John
authors.initials: J
authors.lastname: McDermott
authors.forename: Munci
authors.initials: M
authors.lastname: Kalayoglu
authors.forename: Dennis G
authors.initials: DG
authors.lastname: Maki
mesh_terms: D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016208:Databases, Factual; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy; D006499:Hepatic Artery / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008107:Liver Diseases / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D016896:Treatment Outcome