Liver Posters

Tuesday July 03, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

P.814 Liver abcesses after liver transplantation

Isabel Lechuga Alonso, Spain

Resident
General Surgery and abdominal organs trasplantation
Hospital Universitario 12 de Octubre

Abstract

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.

Presentations by Isabel Lechuga Alonso



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