Surveillance of perioperative infections after adult living donor liver transplantation.
OBJECTIVE
This study was conducted to clarify the management of perioperative infectious complications after adult living donor liver transplantation (LDLT).


METHODS
Fourteen adult LDLT patients were enrolled in this study. We examined the occurrence of infectious complications in these cases and the relationships of infectious complications to UNOS status and MELD score. Surveillance culture and immunoserologic analyses were performed. From the results of these analyses, we made a diagram of infection surveillance using a matrix of time and sampling site. Using the diagram, we chose sensitive antibiotics as soon as possible.


RESULTS
The infection site and its pathogen were able to be detected in four (28.5%) patients, all of whom had MRSA infections, together with lung aspergillosis in one case, pseudomonas pneumonia in another, and both in another. Two patients died of lung aspergillosis. Bacteria detected in the airway tended to spread to other sites during the postoperative period. In all four patients in whom infectious diseases were detected, and in a fifth patient in whom the site of infection was not known, the UNOS status was 1. The MELD score was calculated in eight patients, six of whom had high MELD scores (>20).


CONCLUSIONS
Most cases were manageable by choosing and changing antibiotics and antifungal drugs according to the results of surveillance cultures twice a week. However, aspergillosis had an extremely poor prognosis. Patients with a high MELD score or low UNOS status, or both, showed poor prognosis; and in them, multiple drug resistance bacteria caused severe perioperative infectious complications.
Matsuo
K
K
Hepato-Biliary-Pancreatic Surgery and Liver Transplantation Division, Department of Gastroenterological Surgery (Department of Surgery II), Yokohama City University Graduate School of Medicine, Yokohama, Japan. k-matsuo@kf6.so-net.ne.jp
Sekido
H
H
Morioka
D
D
Sugita
M
M
Nagano
Y
Y
Takeda
K
K
Kubota
T
T
Tanaka
K
K
Masui
H
H
Endo
I
I
Togo
S
S
Shimada
H
H
D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D002177:Candidiasis / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D012189:Retrospective Studies