Hepatic gas gangrene following orthotopic liver transplantation: three cases treated with re-transplantation and a review of the literature.
Gas gangrene is a rare and devastating infectious process that can occur after liver transplantation, most often following hepatic artery thrombosis. We here report 3 cases of gas gangrene following orthotopic liver transplantation. Blood cultures were positive for Clostridium clostridiiforme in one case. In 2 other cases liver tissue from explanted specimens was positive for Enterobacter cloacae. Ultrasound demonstrated hepatic artery thrombosis and computed tomography imaging revealed diffuse liver necrosis with gas formation in each case. All 3 patients were successfully treated with a combination of antibiotics and emergent re-transplantation. We review previously published cases of gas gangrene after liver transplant and emphasize the importance of hepatic artery thrombosis in the development of this syndrome as well as the frequent involvement of non-clostridial organisms. Early diagnosis and aggressive combined medical and surgical treatment including re-transplantation are essential for successful treatment of these rare and catastrophic infections.
Doblecki-Lewis
S
S
Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. sdoblecki@med.miami.edu
Palaios
E
E
Bejarano
P A
PA
Tzakis
A G
AG
Selvaggi
G
G
Morris
M I
MI
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001769:Blood / Q000382:microbiology; D003013:Clostridium / Q000302:isolation & purification; D003015:Clostridium Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D003470:Culture Media; D016972:Enterobacter cloacae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005738:Gas Gangrene / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003470:Culture Media