Tuesday July 03, 2018 from 16:30 to 17:30
Liver Abcesses After Liver Transplantation
Iago Justo 1, Isabel Lechuga1, Anisa Nutu1, Pilar Del Pozo1, María García-Conde1, Alberto Marcacuzco1, Oscar Caso1, Felix Cambra1, Felix Cambra1, Jorge Calvo1, Alejandro Manrique1, Alvaro García-Sesma1, Laura Alonso1, Laura Alonso1, Santiago Salamea1, Carlos Muñoz1, Carlos Jimenez-Romero1.
1General Surgery, "12 de Octubre" U. H., Madrid, Spain
Introduction: Liver abscess after orthotopic liver transplantation (OLT) is a rare but life-threatening complication. Currently, with more accurate diagnostic techniques, enhanced treatments and improvements of intensive care, mortality has been reduced to 5-30%.
Materials and Methods: We perform a retrospective review of the patients who developed one or more liver abscess among a series of 984 patients who underwent OLT between January 2000 and December 2016. An abscess was defined as a radiological hepatic lesion, positive liver aspirates and/or concurrent blood cultures, and compatible clinical findings.
Results: Fourteen patients (1.5%) developed 18 episodes of liver abscesses, and the median time from OLT to the diagnosis of liver abscess was 39.7 months (range: 1.6-285). Main predisposing factors were biliary strictures in 11 patients, hepatic artery thrombosis (HAT) in 8, previous re-OLT in 3, choledocho-jejunostomy in 2, living-donor-liver-OLT in 2, deceased-donor-death in 1, split-liver in 1, and liver biopsy in 1. All patients were managed by intravenous antibiotics, and percutaneous drainage was performed in 10 patients, while 2 patients underwent re-OLT. The mortality rate related with liver abscesses was 21.4% (3 patients). The mean hospital stay was 30+19 days, and during a mean follow-up of 93+78 months three other patients died.
Discussion: The most important risk factors associated with hepatic abscess are HAT (etiology between 13.3%-66% of the cases), biliary stricture and use of donors after cardiac death. E. coli and Klebsiella pneumoniae are the most frequent organisms isolate. When antibiotic therapy and percutaneous drainage fail, a liver re-OLT must be considered in order to prevent the high mortality associated with this severe complication.
Conclusion: Liver abscesses must be managed with antibiotic therapy and percutaneous drainage, but when these conservative measures fail, a liver re-OLT must be performed.