title: Bacterial sepsis after living donor liver transplantation: the impact of early enteral nutrition.
abstract: BACKGROUND
  Bacterial sepsis is a significant problem that must be addressed after living donor liver transplantation (LDLT).
  
  
  METHODS
  A retrospective analysis of 346 adult-to-adult LDLT patients was performed.
  
  
  RESULTS
  Forty-six patients (13.3%) experienced bacterial sepsis, with primary and secondary origins in 23.9% and 76.1%, respectively. Gram-negative bacteria accounted for 71.7% of the bacteria isolated. The 2-year cumulative graft survival rate in patients with bacterial sepsis was 45.7%. Patients with bacterial sepsis secondary to pneumonia (n = 12) had poorer 2-year graft survival rates (16.7%) than did those with primary or other types of secondary sepsis (p = 0.004). Multivariate analysis showed that intraoperative massive blood loss >10L (p < 0.001) and no enteral feeding started within 48 hours after transplantation (p = 0.005) were significant risk factors for bacterial sepsis. Among patients who received enteral nutrition, the incidences of bacterial sepsis in patients who received enteral nutrition within 48 hours (n = 135) or later than 48 hours (n = 57) were 5.9% and 21.0%, respectively (p = 0.002). The incidence of early graft loss was 8-fold higher in recipients with massive intraoperative blood loss without early enteral nutrition (p < 0.001).
  
  
  CONCLUSIONS
  Early enteral nutrition was associated with significantly reduced risk of developing bacterial sepsis after LDLT.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. tikesurg@yahoo.co.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Shohei
authors.initials: S
authors.lastname: Yoshiya
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000209:etiology* / Q000517:prevention & control; D016063:Blood Loss, Surgical; D061345:Early Medical Intervention; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D006085:Graft Survival; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology* / Q000517:prevention & control