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Yoshiya S, Itoh S, Toshima T, Bekki Y, Izumi T, Iseda N, Tsutsui Y, Toshida K, Nakayama Y, Ishikawa T, Yoshizumi T. The impact of perioperative synbiotics treatment in living-donor liver transplantation after induction of early enteral nutrition. Surg Today 2024:10.1007/s00595-024-02918-7. [PMID: 39158605 DOI: 10.1007/s00595-024-02918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/21/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Infectious complications, particularly post-transplant sepsis, have a critical impact on postoperative outcomes. This study examined the effects of perioperative synbiotic treatment on postoperative outcomes in patients receiving early enteral nutrition. METHODS We reviewed 210 living-donor liver transplantation procedures and retrospectively analyzed the postoperative outcomes with and without perioperative synbiotic treatment (live lactic acid bacteria, bifidobacteria, and oligosaccharides) 5 days before and after living-donor liver transplantation. RESULTS The synbiotic group (n = 34) had significantly fewer male donors (38.2% vs. 61.9%, p = 0.011) and a higher proportion of ABO-incompatible grafts (52.9% vs. 25.6%, p = 0.021) than the non-synbiotic group (n = 176). The incidence of sepsis was significantly lower in the synbiotic group than in the non-synbiotic group (0% vs. 7.4%, p = 0.029), with a lower incidence rate of sepsis due to bacteremia with intestinal bacteria (0% vs. 4.6%, p = 0.089). There were no significant differences in the proportions of acute rejection, small-for-size graft syndrome, or postoperative liver function between the two groups. Furthermore, there was no significant difference in the graft survival rates after LDLT between two groups. (p = 0.24). CONCLUSION Perioperative synbiotic treatment prevents post-transplant sepsis, even with early enteral nutrition.
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Affiliation(s)
- Shohei Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuki Bekki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuma Izumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Norifumi Iseda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuriko Tsutsui
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Katsuya Toshida
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuki Nakayama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Takuma Ishikawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Kitt E, Stephens-Shields AJ, Huang YSV, Bittermann T, Fisher BT. Comparative Effectiveness of Perioperative Antibiotic Regimens to Prevent Surgical Site Infections in Pediatric Liver Transplant Recipients. Clin Infect Dis 2024; 79:263-270. [PMID: 38381580 DOI: 10.1093/cid/ciae095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are a common complication in liver transplant (LT) recipients. Lack of pediatric prophylaxis guidelines results in variation in preventative antibiotic regimens. METHODS We performed a retrospective observational study of LT recipients <18 years old using a merged data set that included data from the Pediatric Health Information System and the United Network for Organ Sharing between 2006 and 2017. The exposure was defined as the antibiotic(s) received within 24 hours of LT, with 6 categories, ranging from narrow (category 1: cefazolin), to broad). The primary outcome was presence or absence of SSI in the index admission. Mixed-effects logistic regression compared the effectiveness of each category in preventing SSI, relative to category 1. RESULTS Of the 2586 LT, 284 (11%) met SSI criteria. The SSI rate was higher in the younger subcohort (16.2%) than in the older (8.6%), necessitating a stratified analysis. Antibiotics from category 5 were most commonly used. In the younger subcohort, the adjusted risk was increased in all categories compared with the reference, most notably in category 3 (odds ratio [OR], 2.58 [95% confidence interval: .69-9.59]) and category 6 (2.76 [.66-11.56]). In the older subcohort, estimated ORs were also increased for each category, most notably in category 4 (2.49 [95% confidence interval: .99-6.27]). None of the ORs suggested benefit from broader-spectrum prophylaxis. Our E-value assessment suggests that it's unlikely there is unmeasured confounding by indication to the degree necessary to revert ORs to protective. CONCLUSIONS There was wide variation in antibiotic prophylaxis. Adjusted analyses did not reveal a protective benefit of broader-spectrum prophylaxis in either subcohort, suggesting that narrower regimens may be adequate.
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Affiliation(s)
- Eimear Kitt
- Division of Infectious Diseases in the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Paediatrics, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Alisa J Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuan-Shung Vera Huang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Therese Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Gastroenterology, Hepatology & Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian T Fisher
- Division of Infectious Diseases in the Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lopez-Lopez V, Hiciano-Guillermo A, Martinez-Alarcon L, Delegido A, Alconchel F, Pons JA, Fernández JÁ, Ríos A, Rodríguez JM, Miura K, Sánchez-Bueno F, Robles-Campos R, Ramírez P. Postoperative negative-pressure incision therapy after liver transplant (PONILITRANS study): A randomized controlled trial. Surgery 2023; 173:1072-1078. [PMID: 36549975 DOI: 10.1016/j.surg.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Postoperative complications of surgical incisions are frequent in liver transplantation. However, evidence justifying the use of incisional negative pressure wound therapy to improve surgical wound outcomes remains limited. METHODS Participating patients were randomly assigned to receive incisional negative pressure wound therapy or standard surgical dressing on the closed surgical incision of the liver transplantation. The primary endpoint was surgical site infection incidence 30 days postoperatively. The secondary endpoints included surgical site events (ie, surgical site infection, dehiscence, hematoma, and seroma) and wound quality of life. RESULTS Between December 2018 and September 2021, 108 patients (54 in the incisional negative pressure wound therapy group and 54 in the control group) were enrolled in this study. The incidence of surgical site infection at 30 days postoperatively was 7.4% in the treatment group and 13% in the control group (P = .34). The rate of surgical site events was similar in the treatment in the and control group (27.8% vs 29.6%, P = .83). In relation to wound quality of life, the mean score was 75.20 ± 7.27 in the incisional negative pressure wound therapy group and 72.82 ± 10.57 in the control group (P = .23). CONCLUSION The prophylactic use of negative pressure wound therapy on primarily closed incisions did not significantly reduce incisional surgical site infection and surgical site event rates after liver transplantation compared with standard surgical dressings.
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Affiliation(s)
- Victor Lopez-Lopez
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain.
| | - Alberto Hiciano-Guillermo
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Laura Martinez-Alarcon
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Ana Delegido
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Felipe Alconchel
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Jose Antonio Pons
- Department of Hepatology, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain
| | - Juan Ángel Fernández
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Antonio Ríos
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - José Manuel Rodríguez
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Francisco Sánchez-Bueno
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain
| | - Pablo Ramírez
- Department of General and Digestive Surgery, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, Murcia, Spain; Digestive and Endocrine Surgery and Transplantation of Abdominal Organs Research Group, Biomedical Research Institute of Murcia, Spain. https://twitter.com/ramirez_cirugia
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Zheng Z, Yu Q, Peng H, Huang L, Zhang W, Shen Y, Feng H, Jing W, Zhang Q. Nomogram-based prediction of portal vein system thrombosis formation after splenectomy in patients with hepatolenticular degeneration. Front Med (Lausanne) 2023; 10:1103223. [PMID: 36910478 PMCID: PMC9996067 DOI: 10.3389/fmed.2023.1103223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Splenectomy is a vital treatment method for hypersplenism with portal hypertension. However, portal venous system thrombosis (PVST) is a serious problem after splenectomy. Therefore, constructing an effective visual risk prediction model is important for preventing, diagnosing, and treating early PVST in hepatolenticular degeneration (HLD) surgical patients. Methods Between January 2016 and December 2021, 309 HLD patients were selected. The data were split into a development set (215 cases from January 2016 to December 2019) and a validation set (94 cases from January 2019 to December 2021). Patients' clinical characteristics and laboratory examinations were obtained from electronic medical record system, and PVST was diagnosed using Doppler ultrasound. Univariate and multivariate logistic regression analyses were used to establish the prediction model by variables filtered by LASSO regression, and a nomogram was drawn. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the differentiation and calibration of the model. Clinical net benefit was evaluated by using decision curve analysis (DCA). The 36-month survival of PVST was studied as well. Results Seven predictive variables were screened out using LASSO regression analysis, including grade, POD14D-dimer (Postoperative day 14 D-dimer), POD7PLT (Postoperative day 7 platelet), PVD (portal vein diameter), PVV (portal vein velocity), PVF (portal vein flow), and SVD (splenic vein diameter). Multivariate logistic regression analysis revealed that all seven predictive variables had predictive values (P < 0.05). According to the prediction variables, the diagnosis model and predictive nomogram of PVST cases were constructed. The AUC under the ROC curve obtained from the prediction model was 0.812 (95% CI: 0.756-0.869) in the development set and 0.839 (95% CI: 0.756-0.921) in the validation set. Hosmer-Lemeshow goodness-of-fit test fitted well (P = 0.858 for development set; P = 0.137 for validation set). The nomogram model was found to be clinically useful by DCA. The 36-month survival rate of three sites of PVST was significantly different from that of one (P = 0.047) and two sites (P = 0.023). Conclusion The proposed nomogram-based prediction model can predict postoperative PVST. Meanwhile, an earlier intervention should be performed on three sites of PVST.
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Affiliation(s)
- Zhou Zheng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Qingsheng Yu
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Hui Peng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Long Huang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Wanzong Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Yi Shen
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Hui Feng
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Wenshan Jing
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
| | - Qi Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China.,Institute of Chinese Medicine Surgery, Anhui Academy of Chinese Medicine, Hefei, Anhui, China
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Effects of Intensive Blood Glucose Control on Surgical Site Infection for Liver Transplant Recipients: A Randomized Controlled Trial. Transplant Proc 2023; 55:170-177. [PMID: 36567173 DOI: 10.1016/j.transproceed.2022.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The evidence supporting intensive blood glucose control to prevent surgical site infections (SSIs) among liver transplant recipients is insufficient. We aimed to assess the effects of postoperative intensive blood glucose control (IBGC) against standard blood glucose control (SBGC) on the incidence of SSIs among adult liver transplant recipients. METHODS We performed a randomized controlled trial (ClinicalTrials.gov identifier NCT03474666). The IBGC target was 80 to 130 mg/dL, and the SBGC target was below 180 mg/dL. Analyses were made on an intention-to-treat basis. RESULTS Of the 41 recipients enrolled onto the trial, 20 were randomly allocated to the IBGC group and 21 to the SBGC group. There were no significant differences in SSIs among recipients allocated to either group (relative risk [RR], 0.78; 95% confidence interval [CI], 0.21-2.88; P = .69). Mean (SD) blood glucose levels were significantly lower in the IBGC group in the 24-hour period after surgery (145.0 [20.7] mg/dL and 230.2 [51.6] mg/dL; P = .001). While there were fewer episodes of hypoglycemia in the IBGC group, this was not statistically significant. There were no episodes of severe hypoglycemia in either group. Hyperglycemia and severe hyperglycemia were significantly more frequent in the SBGC group (RR, 0.70; 95% CI, 0.52-0.93; P = .001 and RR, 0.07; 95% CI, 0.01-0.48; P = .001, respectively). Length of hospital stay was significantly shorter for recipients in the IBGC group (13.1 [5.5] days vs 19.3 [12.1] days; P = .04). CONCLUSIONS Although this small trial did not find intensive control reduced SSI, it was associated with lower blood glucose levels, fewer episodes of hyperglycemia and severe hyperglycemia, and shorter length of hospital stay.
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Mallick S, Kathirvel M, Nair K, Durairaj MS, Varghese CT, Sivasankara Pillai Thankamony Amma B, Balakrishnan D, Gopalakrishnan U, Othiyil Vayoth S, Sudhindran S. A randomized, double-blinded, placebo-controlled trial analyzing the effect of synbiotics on infectious complications following living donor liver transplant-PREPRO trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1264-1273. [PMID: 35583161 DOI: 10.1002/jhbp.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Following liver transplantation (LT), bacterial infections occur in over 70% of recipients leading to significant morbidity and mortality. While synbiotics have been reported to decrease infectious complications in various surgical procedures, the evidence of their benefits following LT remains limited. METHODS In this 18-month double-blinded, investigator-initiated, placebo-controlled trial, 100 recipients of live donor liver transplant (LDLT) were randomized to receive either the synbiotic drug Prowel® (Prepro arm) or a placebo, starting 2 days pretransplant and continued for 2 weeks. The primary endpoint was culture-proven bacterial infection in blood, urine or drain fluid within 30 days. Secondary endpoints were hospital stay, noninfectious complications, antibiotic usage and 30-day mortality. RESULTS Overall infectious complications were significantly lower in the Prepro arm in comparison to the Placebo arm (44% vs 22%, P = .019, OR 0.359; CI: 0.150-0.858). Blood stream infections were significantly less in the study arm (21.7% vs 53.3%, P = .020, OR 0.243; CI: 0.072-0.826), whereas urinary tract and intra-abdominal infections were similar. Length of hospital stay, noninfectious complications, deviation from protocol antibiotics and 30-day mortality were comparable. CONCLUSION Synbiotics administered for 2 weeks following LDLT significantly reduced overall and blood stream infectious complications in the early postoperative period. However, there was no difference in hospital stay, noninfectious complications, antibiotic usage and mortality. Clinical Trial Registry of India registration number - CTRI/2017/09/009869.
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Affiliation(s)
- Shweta Mallick
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Manikandan Kathirvel
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Krishnanunni Nair
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Madhu S Durairaj
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Christi Titus Varghese
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | - Dinesh Balakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Unnikrishnan Gopalakrishnan
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Sudheer Othiyil Vayoth
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Surendran Sudhindran
- Department of Gastrointestinal Surgery and Solid Organ Transplantation, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Carugati M, Arif S, Sudan DL, Collins BH, Haney JC, Schroder JN, Reynolds JM, Lewis SS, Yarrington ME, Miller RA, Alexander BD. Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study. Am J Transplant 2022; 22:3021-3030. [PMID: 36056456 DOI: 10.1111/ajt.17189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult SOT recipients at Duke University over a 5-year period (2015-2019). Among 2073 consecutive SOT recipients, 198 IP-SSI were identified. The IP-SSI rate declined over the period (14.4% in 2015 vs. 8.3% in 2019) and was higher among multi-organ compared with single-organ transplants (33.9% vs. 8.1%, p < .01). SOT recipients with IP-SSI had longer hospital stays than patients without SSI (30.0 vs. 17.0 days, p < .01). Transplant hospitalization (9.6% vs. 2.2%, p < .01), 6-month (11.6% vs. 3.3%, p < .01), and 1-year mortality (15.7% vs. 5.8%, p < .01) were higher in SOT recipients with IP-SSI than in those without. While Gram-positive bacteria were the most common pathogens, urogenital Mollicute and atypical Mycobacteria were identified as an unexpected cause of IP-SSI, particularly among lung transplant recipients. The median time to IP-SSI was 24.0 (IQR 13.8-48.3) days, although the time to IP-SSI varied based on organ transplanted and the causative pathogen. IP-SSI is an important and potentially modifiable complication of SOT, associated with prolonged hospitalizations and reduced survival, particularly in the lung transplant population.
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Affiliation(s)
- Manuela Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Sana Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Debra Lynn Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - Bradley Henry Collins
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - John Carroll Haney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob Niall Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - John Michael Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University, Durham, North Carolina, USA
| | - Sarah Stamps Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | | | - Rachel Ann Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara Dudley Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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8
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Aksoy F, Dündar HZ, Kaya E. Duration of operation and diagnosis of hepatitis B (HBV) is an independent risk factor for surgical site infections after liver transplantation. Turk J Surg 2022; 38:289-293. [PMID: 36846064 PMCID: PMC9948667 DOI: 10.47717/turkjsurg.2022.4790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/26/2022] [Indexed: 03/01/2023]
Abstract
Objectives Surgical site infections (SSI) are the most common complications after liver transplantation (LT). Although there are some risk factors known in the literature after LT, the available data is insufficient for routine use. In the present study, it was aimed to define the parameters that may be used to clearly determine the risk of SSI after LT in our clinic. Material and Methods In the present study, we evaluated 329 patients who underwent liver transplantation with regard to risk factors for surgical site infections. The relation between demographic data and SSI was evaluated using SPSS, Graphpad, and Medcalc statistical programs. Results In a total of 329 patients, SSIs were determined in 37 (11.24%). Among the 37 patients, 24 were classified as organ space (64.9%) and 13 as deep SSI (35.1%). None of these patients developed superficial incisional infection. SSI showed statistically significant relation with operation time (p= 0.008), diabetes (p= 0.004), and cirrhosis due to hepatitis B (p <0.001). Conclusion As a result, deep and organ space infections are much more observed in patients undergoing liver transplantation with hepatitis B, diabetes mellitus and prolonged surgery. This is thought to have developed because of chronic irritation and increased inflammation. Since data on hepatitis B and duration of surgery are limited in the literature, this study is considered to be a contribution to the literature.
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Affiliation(s)
- Fuat Aksoy
- Department of General Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Halit Ziya Dündar
- Department of General Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Ekrem Kaya
- Department of General Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
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9
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Eliminated routine postorthotopic liver transplant antibiotics in uncomplicated patients leads to equivalent safety outcomes. ANTIMICROBIAL STEWARDSHIP AND HEALTHCARE EPIDEMIOLOGY 2022; 2:e13. [PMID: 36310805 PMCID: PMC9614830 DOI: 10.1017/ash.2021.239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
Objective: The purpose of this retrospective study was to evaluate safety and efficacy end points of a postoperative antibiotic prophylaxis protocol in liver transplant (LT) patients, which was revised to limit antibiotic use. Methods: In the routine antibiotics group (RA), patients routinely received prophylactic antibiotics for around 3 days postoperatively for a variety of rationales, versus the limited antibiotics group (LA), in which patients received antibiotics for the treatment of secondary peritonitis. Patients were included if they were 18 or older and underwent liver transplant between January 2016 and September 2019. In total, 216 patients remained after exclusion: 118 patients in the RA group and 98 patients in the LA group. Results: We detected a significant difference in the primary end point of postoperative antibiotic days of therapy. The median days of therapy was 2 for the RA group and 0 for the LA group (P < 0.005). Significantly fewer patients received only intraoperative antibiotics in the RA group versus the LA group: 42 (35.6%) versus 76 (73.5%) respectively (P < .005). There was no significant difference in secondary or safety outcomes, including surgical site infections. Conclusions: This study provides evidence that limiting the duration of prophylactic antibiotics postoperatively and treating most patients with only intraoperative antibiotics is safe.
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10
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Shaylor R, Desmond F, Lee DK, Koshy AN, Hui V, Tang GT, Fink M, Weinberg L. The Impact of Intraoperative Donor Blood on Packed Red Blood Cell Transfusion During Deceased Donor Liver Transplantation: A Retrospective Cohort Study. Transplantation 2021; 105:1556-1563. [PMID: 33464032 PMCID: PMC8221718 DOI: 10.1097/tp.0000000000003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blood from deceased organ donors, also known as donor blood (DB), has the potential to reduce the need for packed red blood cells (PRBCs) during liver transplantation (LT). We hypothesized that DB removed during organ procurement is a viable resource that could reduce the need for PRBCs during LT. METHODS We retrospectively examined data on LT recipients aged over 18 y who underwent a deceased donor LT. The primary aim was to compare the incidence of PRBC transfusion in LT patients who received intraoperative DB (the DB group) to those who did not (the nondonor blood [NDB] group). RESULTS After a propensity score matching process, 175 patients received DB and 175 did not. The median (first-third quartile) volume of DB transfused was 690.0 mL (500.0-900.0), equivalent to a median of 3.1 units (2.3-4.1). More patients in the NDB group received an intraoperative PRBC transfusion than in the DB group: 74.3% (95% confidence intervals, 67.8-80.8) compared with 60% (95% confidence intervals, 52.7-67.3); P = 0.004. The median number of PRBCs transfused intraoperatively was higher in the NDB group compared with the DB group: 3 units (0-6) compared with 2 units (0-4); P = 0.004. There were no significant differences observed in the secondary outcomes. CONCLUSIONS Use of DB removed during organ procurement and reinfused to the recipient is a viable resource for reducing the requirements for PRBCs during LT. Use of DB minimizes the exposure of the recipient to multiple donor sources.
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Affiliation(s)
- Ruth Shaylor
- Department of Anesthesia, Austin Health, Heidelberg, VIC, Australia
| | - Fiona Desmond
- Department of Anesthesia, Austin Health, Heidelberg, VIC, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | | | - Victor Hui
- Department of Anesthesia, Austin Health, Heidelberg, VIC, Australia
| | - Gia Toan Tang
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
| | - Michael Fink
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
| | - Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
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11
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Leibovici-Weissman Y, Anchel N, Nesher E, Leshno M, Shlomai A. Early post-liver transplantation infections and their effect on long-term survival. Transpl Infect Dis 2021; 23:e13673. [PMID: 34153169 DOI: 10.1111/tid.13673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infections post-liver transplantation are major drivers for morbidity and mortality. However, the impact of infections within 180 days post-liver transplantation on long-term survival is not clear. METHODS We present a retrospective cohort of 317 liver transplant patients for whom all infectious episodes were prospectively collected during a mean follow-up of 4.4 years. RESULTS A total of 143/317 (45%) of patients suffered from any infectious episode during the first 6 months following liver transplantation. Patients with surgical site infections have a reduced survival compared to those with no infection (HR 0.33, 95% CI 0.172-0.636, P = .001), whereas infections from other sources, including pneumonia, UTI, and line-related infections, were not associated with increased mortality. Furthermore, even though the presence of any infection within 30 days or 6 months post-transplantation did not affect survival, more than a single infectious episode per patient was significantly associated with increased mortality (HR 1.70, CI 1.12-2.60, P = .013). In a multivariate analysis, the number of infectious episodes remained statistically significant (HR 1.58, 95% CI 1.03-2.43, P = .035) upon adjustment for other major variables associated with comorbidities and infection risk. CONCLUSIONS Surgical site infections and the number of infectious episodes within 180 days post-liver transplantation are major determinants of long-term survival among these patients.
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Affiliation(s)
- Yaara Leibovici-Weissman
- Department of Medicine D, Rabin Medical Center, Liver Institute, Beilinson Hospital, Petah-Tikva, Israel.,Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Noa Anchel
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Eviatar Nesher
- The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.,Department of Organ Transplantation, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Moshe Leshno
- The Coller School of Management, Tel Aviv University, Ramat Aviv, Israel
| | - Amir Shlomai
- Department of Medicine D, Rabin Medical Center, Liver Institute, Beilinson Hospital, Petah-Tikva, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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12
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Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature. World J Emerg Surg 2021; 16:33. [PMID: 34112231 PMCID: PMC8194010 DOI: 10.1186/s13017-021-00375-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients. METHODS A systematic review of the literature was conducted. RESULTS Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed. CONCLUSION Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.
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13
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Ma M, Wang X, Li J, Jiang W. Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta-analysis. Nutr Clin Pract 2021; 36:808-819. [PMID: 33955611 DOI: 10.1002/ncp.10650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Probiotics were used for liver transplantation (LT) patients to reduce postoperative infection, but clinical trials examining the combined use of prebiotics and probiotics are limited. This meta-analysis aimed to compare the safety and efficacy of combined use of prebiotics and probiotics in patients undergoing LT. PubMed, Cochrane, and Embase databases were reviewed for the combined use of prebiotics and probiotics in patients undergoing LT. The weighted mean difference (WMD), risk ratio (RR), and 95% CI were calculated. A total of 6 related studies comprising 345 patients were included. Most prebiotics and probiotics were given for 7.14 days. The overall infection rate (RR = 0.29; 95% CI, 0.14.0.60; P value for heterogeneity [PH ] = .066; test for heterogeneity [I2 ] = 51.7%) and the incidence of urinary tract infection (RR = 0.14; 95% CI, 0.04-0.47, PH = .724; I2 = 0%) were lower in the probiotics group when compared with those in the control group. Furthermore, probiotics significantly reduced the hospital length of stay (WMD = -1.37; 95% CI, -1.92 to 0.82; PH = .506; I2 = 0%) and the duration of antimicrobial therapy (WMD = -4.31; 95% CI, -5.41 to 3.22; PH = .019; I2 = 69.8%) in patients undergoing LT. These findings suggested that the combined use of prebiotics and probiotics (Lactobacillus and Bifidobacterium) was effective in lowering the incidence of bacterial infections and shortening the hospital length of stay and duration of antibiotic therapy in patients undergoing LT, when compared with conventional nutrition.
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Affiliation(s)
- Ming Ma
- Department of Liver Transplantation Surgery, Tianjin Medical University, Tianjin, China.,Department of Liver Transplantation Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Xiaodong Wang
- Department of Liver Transplantation Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Junjie Li
- Department of Liver Transplantation Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Wentao Jiang
- Department of Liver Transplantation Surgery, Tianjin First Central Hospital, Tianjin, China
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14
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Chea N, Sapiano MRP, Zhou L, Epstein L, Guh A, Edwards JR, Allen-Bridson K, Russo V, Watkins J, Pouch SM, Magill SS. Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015-2018. Transpl Infect Dis 2021; 23:e13589. [PMID: 33617680 PMCID: PMC8380253 DOI: 10.1111/tid.13589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 01/22/2023]
Abstract
Liver transplant recipients are at high risk for surgical site infections (SSIs). Limited data are available on SSI epidemiology following liver transplant procedures (LTPs). We analyzed data on SSIs from 2015 to 2018 reported to CDC's National Healthcare Safety Network to determine rates, pathogen distribution, and antimicrobial resistance after LTPs and other hepatic, biliary, or pancreatic procedures (BILIs). LTP and BILI SSI rates were 5.7% and 5.9%, respectively. The odds of SSI after LTP were lower than after BILI (adjusted odds ratio = 0.70, 95% confidence interval 0.57-0.85). Among LTP SSIs, 43.1% were caused by Enterococcus spp., 17.2% by Candida spp., and 15.0% by coagulase-negative Staphylococcus spp. (CNS). Percentages of SSIs caused by Enterococcus faecium or CNS were higher after LTPs than BILIs, whereas percentages of SSIs caused by Enterobacteriaceae, Enterococcus faecalis, or viridans streptococci were higher after BILIs. Antimicrobial resistance was common in LTP SSI pathogens, including E. faecium (69.4% vancomycin resistant); Escherichia coli (68.8% fluoroquinolone non-susceptible and 44.7% extended spectrum cephalosporin [ESC] non-susceptible); and Klebsiella pneumoniae and K. oxytoca (39.4% fluoroquinolone non-susceptible and 54.5% ESC non-susceptible). National LTP SSI pathogen and resistance data can help prioritize studies to determine effective interventions to prevent SSIs and reduce antimicrobial resistance in liver transplant recipients.
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Affiliation(s)
- Nora Chea
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Lantana Consulting Group, Inc, East Thetford, VT, USA
| | - Liang Zhou
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | - Lauren Epstein
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alice Guh
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan R Edwards
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine Allen-Bridson
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Victoria Russo
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | - Jennifer Watkins
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.,CACI Inc., Atlanta, GA, USA
| | | | - Shelley S Magill
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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15
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Hreńczuk M, Biedrzycka A, Łągiewska B, Kosieradzki M, Małkowski P. Surgical Site Infections in Liver Transplant Patients: A Single-Center Experience. Transplant Proc 2020; 52:2497-2502. [PMID: 32362463 DOI: 10.1016/j.transproceed.2020.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
AIM The aim of the study was a single-center assessment of occurrence of surgical site infections (SSI) in patients after liver transplantation and an attempt to determine factors that may contribute to this complication. PATIENTS AND METHODS Analysis of medical records of 60 adult patients, who underwent first transplantation in 2016 and 2017 was conducted. Selected pre-, intra-, and postoperative factors were assessed. Statistical analysis was performed with StatSoft Statistica 13.1 PL package. RESULTS SSI occurred in 25% of liver recipients, with average timing of diagnosis on the 14th day after surgery. Mean duration of hospitalization was significantly longer in patients who experienced SSI than in patients without this complication (35.8 ± 8.9 days vs 25.2 ± 6 days, P < .0001). SSI occurred a little more frequently in men and older recipients, as well as in overweight and underweight patients (not significant). An indication for transplantation did not have an impact on SSI occurrence. The complication was more likely in patients with diabetes and renal failure prior to transplantation (P > .05). Duration of the procedure, blood loss and prolonged drainage did not have any impact on SSIs. SSI was significantly more common in recipients with lower total protein value (P < .0002) and anemia (P < .0002) in early postoperative period. CONCLUSION Among the studied population, a high incidence of SSI was noted, and that some of the identified risk factors differ from those described in the literature.
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Affiliation(s)
- Marta Hreńczuk
- Department of Surgical and Transplantation Nursing, and Extracorporeal Treatment, Faculty of Health Sciences, Medical University of Warsaw, Poland.
| | - Anna Biedrzycka
- Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Beata Łągiewska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Piotr Małkowski
- Department of Surgical and Transplantation Nursing, and Extracorporeal Treatment, Faculty of Health Sciences, Medical University of Warsaw, Poland
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16
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Aktas A, Kayaalp C, Gunes O, Gokler C, Uylas U, Cicek E, Ersoy Y, Kose A, Bayindir Y, Aydin C, Yilmaz S. Surgical site infection and risk factors following right lobe living donor liver transplantation in adults: A single-center prospective cohort study. Transpl Infect Dis 2019; 21:e13176. [PMID: 31539456 DOI: 10.1111/tid.13176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/07/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Surgical site infection (SSI) is an important cause of decreased graft survival, prolonged hospital stay, and higher costs following living donor liver transplantation. There are several risk factors for SSI. In this cohort study, we aimed to investigate the incidence of SSI at our center and the associated risk factors. MATERIALS AND METHODS Adult right lobe living donor liver transplantations were included in this prospective cohort. Patients who died postoperatively within 3 days; patients with infected ascites or open abdomen, cadaveric, or pediatric transplants; and patients with biologic or cryopreserved vascular grafts were excluded. Patients' demographic characteristics and perioperative surgical findings were recorded. SSI follow-up was continued for 90 days. CDC-2017 criteria were used to diagnose SSI. In the presence of superficial, deep, and organ/space SSI, only the organ in the poorest condition was included in SSI evaluation. The patients were administered similar to antibiotic prophylaxes and immunosuppressive protocols. RESULTS A total of 101 patients were enrolled in this study, of which 30 (29.7%) were diagnosed with SSI. Organ/space, only deep, and only superficial SSI were noted in 90% (27/30), 6.7% (2/30), and 3.3% (1/30) of the patients, respectively. Twenty-five of 30 patients with SSI had a remote site infection. One or more bacteria observed in cultures were obtained from 28 patients. A donor-recipient age difference of >10 years, cold ischemia lasting for ≥150 minutes, surgical duration of ≥600 minutes, intraoperative hemorrhage of ≥1000 mL, intraoperative blood transfusion, biliary leak or stricture, prolonged mechanical ventilation, prolonged intensive care unit and hospital stay, remote site infection, and the need for reoperation were associated with increased SSI incidence. Preoperative and intraoperative levels of blood glucose, albumin, and hemoglobin were not associated with SSI. A donor-recipient age difference of >10 years, remote site infection, and biliary leak were found to be independent risk factors for SSI. Hospital mortality with and without SSIs was 6.7% vs 4.4%, P = .61. DISCUSSION Organ/space SSIs were the essential part of SSIs following right lobe living donor liver transplantations. Donor-recipient age gap, prolonged cold ischemia time, complicated surgery, and postoperative biliary complications were the main causes of SSIs. Although they did not increase the perioperative mortality, they promote increased rate of reoperations, remote infections, prolonged intensive care unit, and hospital stays.
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Affiliation(s)
- Aydin Aktas
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Orgun Gunes
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Cihan Gokler
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Ufuk Uylas
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Egemen Cicek
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Yasemin Ersoy
- Infectious Disease, Inonu University, Malatya, Turkey
| | - Adem Kose
- Infectious Disease, Inonu University, Malatya, Turkey
| | | | - Cemalettin Aydin
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplantation Institute, Inonu University, Malatya, Turkey
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17
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Parekh JR, Greenstein S, Sudan DL, Grieco A, Cohen ME, Hall BL, Ko CY, Hirose R. Beyond death and graft survival-Variation in outcomes after liver transplant. Results from the NSQIP transplant beta phase. Am J Transplant 2019; 19:2108-2115. [PMID: 30887634 DOI: 10.1111/ajt.15357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 01/25/2023]
Abstract
The National Surgical Quality Program (NSQIP) Transplant program was designed by transplant surgeons from the ground up to track posttransplant outcomes beyond basic recipient and graft survival. After an initial pilot phase, the program has expanded to 29 participating sites and enrolled more than 4300 recipient-donor pairs into the database, including 1444 completed liver transplant cases. In this analysis, surgical site infection (SSI), urinary tract infection (UTI), and unplanned reoperation/intervention after liver transplantation were evaluated. We observed impressive variation in the crude incidence between sites for SSI (0%-29%), UTI (0%-10%), and reoperation/intervention (0%-57%). After adjustment for donor and recipient factors, at least 1 site was identified as an outlier for each of the analyzed outcomes. For the first time, the field of transplantation has data that demonstrate variation in liver recipient outcomes beyond death and graft survival between sites. More importantly, NSQIP Transplant provides a powerful platform to improve care beyond basic patient and graft survival.
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Affiliation(s)
- Justin R Parekh
- Department of Surgery, University of California San Diego, San Diego, California
| | - Stuart Greenstein
- Montefiore Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Debra L Sudan
- Division of Abdominal Transplant Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | | | | | - Bruce L Hall
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, Washington University in St. Louis, Saint Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Center for Health Policy and the Olin Business School, Washington University in St. Louis, St. Louis, Missouri
| | - Clifford Y Ko
- American College of Surgeons, Chicago, Illinois.,Department of Surgery, University of California Los Angeles David Geffen School of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ryutaro Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
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18
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Abbo LM, Grossi PA. Surgical site infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13589. [PMID: 31077619 DOI: 10.1111/ctr.13589] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
These guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of post-operative surgical site infections (SSIs) in solid organ transplantation. SSIs are a significant cause of morbidity and mortality in SOT recipients. Depending on the organ transplanted, SSIs occur in 3%-53% of patients, with the highest rates observed in small bowel/multivisceral, liver, and pancreas transplant recipients. These infections are classified by increasing invasiveness as superficial incisional, deep incisional, or organ/space SSIs. The spectrum of organisms implicated in SSIs in SOT recipients is more diverse than the general population due to other important factors such as the underlying end-stage organ failure, immunosuppression, prolonged hospitalizations, organ transportation/preservation, and previous exposures to antibiotics in donors and recipients that could predispose to infections with multidrug-resistant organisms. In this guideline, we describe the epidemiology, clinical presentation, differential diagnosis, potential pathogens, and management. We also provide recommendations for the selection, dosing, and duration of peri-operative antibiotic prophylaxis to minimize post-operative SSIs.
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Affiliation(s)
- Lilian M Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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19
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Oliveira RA, Mancero JMP, Faria DF, Poveda VDB. A Retrospective Cohort Study of Risk Factors for Surgical Site Infection Following Liver Transplantation. Prog Transplant 2019; 29:144-149. [DOI: 10.1177/1526924819835831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. Methods: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. Results: We enrolled 156 recipients’ medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum β-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). Conclusions: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.
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Affiliation(s)
- Ramon Antônio Oliveira
- Graduate Program in Adult Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
| | - Jorge Marcelo Padilla Mancero
- Liver Transplantation Department, Hospital Santa Casa of São Jose dos Campos, São José dos Campos, São Paulo, Brazil
| | - Dalila Fernanda Faria
- Liver Transplantation Department, Hospital Santa Casa of São Jose dos Campos, São José dos Campos, São Paulo, Brazil
| | - Vanessa de Brito Poveda
- Graduate Program in Adult Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
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20
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Abstract
STUDY DESIGN Retrospective literature review of spine surgical site infection (SSI). OBJECTIVE To perform a review of SSI risk factors and more specifically, categorize them into patient and surgical factors. METHODS A review of published literature on SSI risk factors in adult spine surgery was performed. We included studies that reported risk factors for SSI in adult spinal surgery. Excluded are pediatric patient populations, systematic reviews, and meta-analyses. Overall, we identified 72 cohort studies, 1 controlled-cohort study, 1 matched-cohort study, 1 matched-paired cohort study, 12 case-controlled studies (CCS), 6 case series, and 1 cross-sectional study. RESULTS Patient-associated risk factors-diabetes mellitus, obesity (body mass index >35 kg/m2), subcutaneous fat thickness, multiple medical comorbidities, current smoker, and malnutrition were associated with SSI. Surgical associated factors-preoperative radiation/postoperative blood transfusion, combined anterior/posterior approach, surgical invasiveness, or levels of instrumentation were associated with increased SSI. There is mixed evidence of age, duration of surgery, surgical team, intraoperative blood loss, dural tear, and urinary tract infection/urinary catheter in association with SSI. CONCLUSION SSIs are associated with many risk factors that can be patient or surgically related. Our review was able to identify important modifiable and nonmodifiable risk factors that can be essential in surgical planning and discussion with patients.
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Affiliation(s)
- Reina Yao
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hanbing Zhou
- University of British Columbia, Vancouver, British Columbia, Canada,Hanbing Zhou, Division of Spine Surgery, Department of Orthopaedics, University of British Columbia, 3114–910 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John Street
- University of British Columbia, Vancouver, British Columbia, Canada
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Huang CJ, Chang CH, Cheng KW, Chen CL, Wu SC, Shih TH, Yang SC, Lee YE, Huang CE, Jawan B, Wang CH, Juang SE. Correlation Between Blood Transfusion and Blood Glucose Levels in Adult Living Donor Liver Transplantation. Transplant Proc 2018; 50:2645-2647. [PMID: 30401367 DOI: 10.1016/j.transproceed.2018.02.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate the effect of dextrose contained in banked blood products on the changes of blood glucose levels in adult living donor liver transplantation patients retrospectively. METHODS Four hundred seventy-seven patients were divided into a non-blood transfusion (BT) group (G1) and a BT group (G2). The changes in blood glucose levels during the operation were compared using a Mann-Whitney U test, and a P value less than .05 was regarded as significant. RESULTS No significant changes were detected in blood glucose levels after anesthesia, during dissection phase, in the anhepatic phase, or after reperfusion between the groups. Estimated blood loss for G1 (n = 89) and G2 (n = 388) were 718 ± 514 and 5804 ± 877 mL respectively, G1 had no blood transfusion but G2 had received 4350 ± 6230 mL leukocyte-poor red blood cell transfusion, the pre- and end operation hemoglobin for G1 and G2 were 13.2 ± 2.0, 10.2 ± 1.9 and 10.1 ± 1.6, 10.2 ± 1.9 mg/dL respectively, indicating that they were not under or over transfused. CONCLUSION When banked blood products are used to replace ongoing blood loss, the dextrose contained in citrate-phosphate-dextrose-adenine seems to have no effect on the changes in the blood glucose levels of the recipients.
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Affiliation(s)
- C-J Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-H Chang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - K-W Cheng
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-L Chen
- Department of Surgery and Liver Transplantation Program, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S-C Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - T-H Shih
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S-C Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Y-E Lee
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-E Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - B Jawan
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - C-H Wang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - S-E Juang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Vesco NDL, Fragoso LVC, Beserra FDM, Aguiar MIFD, Alves NP, Bonates LAM. INFECÇÕES RELACIONADAS À ASSISTÊNCIA À SAÚDE E FATORES ASSOCIADOS NO PÓS-OPERATÓRIO DE TRANSPLANTE HEPÁTICO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720180002150017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
RESUMO Objetivo: identificar a incidência das infecções relacionadas à assistência à saúde e seus fatores associados, durante o primeiro mês do pós-operatório de pacientes adultos submetidos ao transplante hepático em um hospital público de Fortaleza. Método: estudo retrospectivo, descritivo com abordagem quantitativa, realizado com 53 receptores de fígado no primeiro semestre do ano de 2015. Os dados foram coletados através dos prontuários, fichas ambulatoriais e de notificação de infecções. Resultados: dos pacientes avaliados, 15 (28,3%) apresentaram infecção durante o primeiro mês, em que o mais prevalente foi a sepse clínica (n=6; 37,4%), seguida de infecção do trato respiratório (n=3; 18,8%), trato urinário (n=3;18,8%), sítio cirúrgico (n=3; 18,8%) e por último, infecção de corrente sanguínea (n=1; 6,2%). Os que apresentaram associação estatística em relação a não ocorrência de infecções foram o grupo dos pacientes casados e a indicação de cirrose por hepatite C. A média dos dias de internação no pós-operatório, o uso do imunossupressor micofenolato de mofetil e a média do uso de alguns dispositivos invasivos, foram identificados como os fatores associados à ocorrência de infecções, sendo estatisticamente significativos para p=<0,05. Conclusão: a identificação da incidência das infecções relacionadas à assistência à saúde e seus fatores associados em pacientes submetidos ao transplante hepático, poderá subsidiar o direcionamento das ações de saúde, com a finalidade de diminuir a morbimortalidade associada às infecções e otimizando a recuperação desses pacientes.
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