Influence of pretransplantation bacterial and fungal culture positivity on outcome after living donor liver transplantation.
BACKGROUND
Bacterial and fungal infections are serious complications in patients with cirrhosis and are among the main causes of morbidity and mortality. The effects of pretransplantation infection on the outcome after orthotopic liver transplantation (OLT), however, have not been fully described.


OBJECTIVE
To assess the influence of pretransplantation infection on OLT by analyzing the clinical profiles of liver recipients with preexisting bacterial or fungal infection.


METHODS
We retrospectively reviewed the medical records of 223 adult patients who underwent living donor OLT between October 1, 2005, and September 30, 2006. In all patients, routine blood culture, was performed, and in patients with suspected bacterial or fungal infection; sputum, urine, and ascitic fluid cultures were performed.


RESULTS
Of 223 patients, 37 (16.6%) had a positive culture in one or more samples. Culture-positive and culture-negative groups differed significantly in end-stage liver disease score but showed no differences in Child-Turcotte-Pugh score, existence of spontaneous bacterial peritonitis, hemodialysis, or duration of stay in the intensive care unit or hospital. Six of 37 patients with positive cultures (16.2%) and 4 (2.2%) of 186 patients with negative cultures (2.2%) died during the first 90 days after OLT (P = .007). The causes of death among culture-positive patients were brain edema (n = 2), brain hemorrhage (n = 1), hepatic dysfunction (n = 1), and sepsis (n = 2), whereas all 4 culture-negative patients died of infectious complications.


CONCLUSIONS
Prompt OLT accompanied by adequate antibiotic or antifungal therapy may be acceptable in patients with preexisting bacterial or fungal infection unless there are overt manifestations of active infection.
Kim
B-S
BS
Department of Surgery, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
Lee
S-G
SG
Hwang
S
S
Ahn
C-S
CS
Kim
K-H
KH
Moon
D-B
DB
Ha
T-Y
TY
Song
G-W
GW
Jung
D-H
DH
D000328:Adult; D001424:Bacterial Infections / Q000150:complications*; D004198:Disease Susceptibility; D005260:Female; D006509:Hepatitis B / Q000382:microbiology / Q000601:surgery; D006526:Hepatitis C / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000382:microbiology / Q000601:surgery; D017093:Liver Failure / Q000382:microbiology / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications*; D011300:Preoperative Care; D016896:Treatment Outcome