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Peritonitis after liver transplantation: Incidence, risk factors, microbiology profiles, and outcome
Author(s) -
Pungpapong Surakit,
Alvarez Salvador,
Hellinger Walter C.,
Kramer David J.,
Willingham Darrin L.,
Mendez Julio C.,
Nguyen Justin H.,
Hewitt Winston R.,
ArandaMichel Jaime,
Harnois Denise M.,
Rosser Barry G.,
Hughes Christopher B.,
Grewal Hani P.,
Satyanarayana Raj,
Dickson Rolland C.,
Steers Jeffrey L.,
Keaveny Andrew P.
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20801
Subject(s) - medicine , liver transplantation , incidence (geometry) , outcome (game theory) , transplantation , spontaneous bacterial peritonitis , peritonitis , risk factor , intensive care medicine , cirrhosis , physics , optics , mathematics , mathematical economics
Peritonitis occurring after liver transplantation (PLT) has been poorly characterized to date. The aims of this study were to define the incidence, risk factors, microbiology profiles, and outcome of nonlocalized PLT. This was a retrospective study of 950 cadaveric liver transplantation (LT) procedures in 837 patients, followed for a mean of 1,086 days (range, 104‐2,483 days) after LT. PLT was defined as the presence of at least one positive ascitic fluid culture after LT. There were 108 PLT episodes in 91 patients occurring at a median of 14 days (range, 1‐102 days) after LT. Significant risk factors associated with the development of PLT by multivariate analysis included pre‐LT model for end‐stage liver disease score, duration of LT surgery, Roux‐en‐Y biliary anastomosis, and renal replacement therapy after LT. Biliary complications, intra‐abdominal bleeding, and bowel leak/perforation were associated with 34.3%, 26.9%, and 18.5% of episodes, respectively. Multiple organisms, gram‐positive cocci, fungus, and multidrug‐resistant bacteria were isolated in 61.1%, 92.6%, 25.9%, and 76.9% of ascitic fluid cultures, respectively. The 28 fungal PLT episodes were associated with bowel leak/perforation and polymicrobial peritonitis. Patients who developed PLT after their first LT had a significantly greater risk of graft loss or mortality compared to unaffected patients. Parameters significantly associated with these adverse outcomes by multivariate analysis were recipient age at LT and bowel leak or perforation after LT. In conclusion, PLT is a serious infectious complication of LT, associated with significant intra‐abdominal pathology and reduced recipient and graft survival. Liver Transpl 12:1244‐1252; 2006. © 2006 AASLD.