title: Bacteriobilia and fungibilia are associated with outcome in patients with endoscopic treatment of biliary complications after liver transplantation.
abstract: OBJECTIVE
  To determine the importance of bacteriobilia and fungibilia in patients with endoscopic treatment of biliary complications after orthotopic liver transplantation (OLT).
  
  
  METHODS
  In a prospective study at a tertiary center, 213 patients underwent 857 endoscopic retrograde cholangiographies (ERCs) after OLT. Findings at first ERC were: anastomotic stricture in 24.4%, nonanastomotic stricture in 18.3%, leakage in 11.3%, and gallstones in 4.7%.
  
  
  RESULTS
  Bile samples from first ERC showed Gram-positive bacterial isolates in 102/180 (57%) and Gram-negative in 44/180 (24%). Main species were Enterococcus spp. (40%; 72/180) and Escherichia coli (10%; 18 /180). Enteric bacteria (present in 47%) and Candida spp. (present in 18%) were both associated with clinical signs of cholangitis, but not with laboratory signs of inflammation. Multiresistant strains (present in 12% of samples) showed no association with clinical or laboratory parameters. Detection of microbiological isolates was independent of endoscopic findings and treatment. In patients with successful endoscopic intervention, the actuarial survival free of retransplantation was significantly lower in those with detection of enteric bacteria, being 51.8 months (95% confidence interval [CI] 42.9-60.6) vs. 62.9 months (95% CI 59.1-66.7); P = 0.025). Fungibilia was associated with significantly lower actuarial retransplantation-free survival, independently of successful endoscopic treatment (mean 35.1 months [95% CI 23.5-46.7] vs. 53.1 months [(95% CI 48.0-58.2]; P = 0.019).
  
  
  CONCLUSIONS
  Bacteriobilia and fungibilia can frequently be detected by routine microbiological sampling in patients after OLT. Regular bile sampling is recommended since the presence of difficult-to-treat multiresistant strains is unpredictable. Survival is affected by this altered biliary microbiological environment after OLT.
authors.affiliation: Department of Gastroenterology, Toxicology, and Infectious Diseases, University Hospital of Heidelberg, Germany.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Gotthardt
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Weiss
authors.forename: Christian
authors.initials: C
authors.lastname: Rupp
authors.forename: Konrad
authors.initials: K
authors.lastname: Bode
authors.forename: Isabella
authors.initials: I
authors.lastname: Eckerle
authors.forename: Gerda
authors.initials: G
authors.lastname: Rudolph
authors.forename: Janine
authors.initials: J
authors.lastname: Bergemann
authors.forename: Petra
authors.initials: P
authors.lastname: Kloeters-Plachky
authors.forename: Fadi
authors.initials: F
authors.lastname: Chahoud
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.forename: Peter
authors.initials: P
authors.lastname: Sauer
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D001646:Bile / Q000382:microbiology*; D002175:Candida / Q000302:isolation & purification; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D016015:Logistic Models; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome