Outcomes of spontaneous bacterial peritonitis in liver transplant recipients with allograft failure.
BACKGROUND
Spontaneous bacterial peritonitis (SBP) carries appreciable morbidity and mortality in the pre-liver transplant (LT) setting. However, the occurrence of SBP and its consequences in the post-LT setting have not been well characterized.


METHODS
This is a retrospective study of SBP occurring in post-LT patients between January 2007 and December 2012. Outcomes were compared to a cohort of post-LT patients with allograft failure and ascites without SBP.


RESULTS
The most common indication for liver transplantation in this cohort was hepatitis C. A total of 29 episodes of SBP in 21 patients were identified. Escherichia coli (19%) and Klebsiella pneumoniae (10%) were the most frequent pathogens identified. Six patients died during their first episode of SBP. Ten patients were eventually listed for liver re-transplantation (re-LT) after their first episode of SBP; 5 of these patients were transplanted and the other 5 died. Of the 5 who were transplanted, 2 died shortly after re-transplant, and 3 are still alive. The cause of death in the majority of patients was infection (83.3%). The median time from onset of ascites to death was 214 days (range: 10-1085 days) and from the first episode of SBP to death was 50.5 days (range: 4-549 days). In contrast, the median time from onset of ascites to death in patients with allograft failure and ascites without SBP was 331.5 days (45-2400 days).


CONCLUSIONS
Allograft failure with ascites is a poor prognostic factor and these patients should be considered high risk for re-LT. SBP may accelerate the time to mortality.
Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J
J
Leong
Division of Infectious Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
S
S
Huprikar
Division of Liver Diseases, Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA.
T
T
Schiano
D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000209:etiology; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000821:virology; D019698:Hepatitis C, Chronic / Q000601:surgery*; D006801:Humans; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
allograft failure; infection; liver transplant; spontaneous bacterial peritonitis