Infected bilomas in liver transplant recipients: clinical features, optimal management, and risk factors for mortality.
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.
Safdar
Nasia
N
Section of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, WI, USA.
Said
Adnan
A
Lucey
Michael R
MR
Knechtle
Stuart J
SJ
D'Alessandro
Anthony
A
Musat
Alexandru
A
Pirsch
John
J
McDermott
John
J
Kalayoglu
Munci
M
Maki
Dennis G
DG
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