title: Subclinical spontaneous bacterial peritonitis at the time of liver transplantation does not impact on outcomes.
abstract: OBJECTIVE
  Liver transplant recipients are often screened for spontaneous bacterial peritonitis during the immediate preoperative evaluation to determine medical fitness to proceed. However, it is unknown whether subclinical spontaneous bacterial peritonitis impacts on post-transplant outcomes. Our aim was to determine whether subclinical spontaneous bacterial peritonitis detected at the preoperative evaluation influences the decision to proceed, and subsequent postoperative morbidity and mortality.
  
  
  METHODS
  This study is a single-centre study of 1231 adults attending for possible first elective single-organ liver transplantation between January 2000 and December 2011.
  
  
  RESULTS
  A total of 434 patients underwent ascitic fluid sampling on 460 occasions. Nineteen samples fulfilled the diagnostic criteria for spontaneous bacterial peritonitis (4.8%), including one that was culture positive (Candida spp.). Patients with spontaneous bacterial peritonitis had a higher serum bilirubin level than nonspontaneous bacterial peritonitis patients (P=0.018). Out of the 19 patients, 16 (84.2%) with a positive sample proceeded to transplantation on that occasion; the ascitic microscopy result did not influence the decision to proceed in any clinically stable patient. The 30-day post-transplant survival was 93.8% for spontaneous bacterial peritonitis patients and 96.2% for nonspontaneous bacterial peritonitis patients (P=0.478). After adjusting for recipient age, UK Score for Patients with End-Stage Liver Disease (UKELD) and donor risk index, there was no association between a positive tap and death within 30 days (P=0.649).
  
  
  CONCLUSIONS
  Subclinical spontaneous bacterial peritonitis is rare in patients admitted for elective liver transplantation, does not influence the decision to proceed and is not associated with increased post-transplant mortality. Our findings suggest that routine preoperative ascitic fluid sampling is not indicated in clinically stable potential transplant recipients.
authors.affiliation: aMedical School bNIHR Biomedical Research Unit and Centre for Liver Research, University of Birmingham cLiver Unit, Queen Elizabeth Hospital, Birmingham dDepartment of Hepatology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Damhnaic P
authors.initials: DP
authors.lastname: McDonald
authors.forename: Joanna A
authors.initials: JA
authors.lastname: Leithead
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Gunson
authors.forename: James W
authors.initials: JW
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D001202:Ascitic Fluid / Q000382:microbiology / Q000473:pathology; D058345:Asymptomatic Infections; D001424:Bacterial Infections / Q000175:diagnosis*; D001663:Bilirubin / Q000097:blood; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010538:Peritonitis / Q000175:diagnosis* / Q000382:microbiology; D057234:Preoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin