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Yokose T, Takeuchi M, Obara H, Shinoda M, Kawakubo H, Kitago M, Yagi H, Abe Y, Yamada Y, Matsubara K, Oshima G, Hori S, Fujimura T, Takemura R, Ishii R, Kuroda T, Kitagawa Y. Diagnostic Utility of Presepsin in Infections After Liver Transplantation: A Preliminary Study. Ann Transplant 2021; 26:e933774. [PMID: 34795199 PMCID: PMC8609769 DOI: 10.12659/aot.933774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Infectious complications after solid organ transplantation can be fatal, and early diagnosis and intervention are important. To the best of our knowledge, no study has examined the diagnostic utility of presepsin, a known accurate biomarker, for infectious complications after liver transplantation. This study aimed to evaluate the utility of presepsin for detecting infection and perioperative kinetics of presepsin after liver transplantation. MATERIAL AND METHODS This single-institutional prospective, observational study included 13 patients who underwent living-donor or deceased-donor liver transplantation. Perioperative serum presepsin level was measured 6 times within a week to evaluate its association with infectious complications and compare it with procalcitonin and C-reactive protein levels and leukocyte count. Postoperatively, patients were followed up for 15 days for infectious complications. RESULTS Five of the 13 patients developed infectious complications after liver transplantation. The median time for infection diagnosis was 9 postoperative days (25th-75th percentile, 7-10). Presepsin levels on 5 and 7 postoperative days were significantly higher in patients with infection than in those without (P=0.019 and P=0.011, respectively). In receiver operating characteristic analysis, area under the curve values of presepsin on 5 and 7 postoperative days (0.881 and 0.905, respectively) were higher than those of other biomarkers. The optimal cut-off value of presepsin was 1361 pg/mL on postoperative day 5 and 1375 pg/mL on postoperative day 7. CONCLUSIONS Although this study included a small number of patients, presepsin levels on postoperative days 5 and 7 may be useful indicators for infectious complications after liver transplantation.
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Affiliation(s)
- Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Masashi Takeuchi
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Masahiro Shinoda
- Digestive Diseases Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yohei Yamada
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Takumi Fujimura
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku, Japan
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2
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Luo Y, Tang Z, Hu X, Lu S, Miao B, Hong S, Bai H, Sun C, Qiu J, Liang H, Na N. Machine learning for the prediction of severe pneumonia during posttransplant hospitalization in recipients of a deceased-donor kidney transplant. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:82. [PMID: 32175375 DOI: 10.21037/atm.2020.01.09] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Pneumonia accounts for the majority of infection-related deaths after kidney transplantation. We aimed to build a predictive model based on machine learning for severe pneumonia in recipients of deceased-donor transplants within the perioperative period after surgery. Methods We collected the features of kidney transplant recipients and used a tree-based ensemble classification algorithm (Random Forest or AdaBoost) and a nonensemble classifier (support vector machine, Naïve Bayes, or logistic regression) to build the predictive models. We used the area under the precision-recall curve (AUPRC) and the area under the receiver operating characteristic curve (AUROC) to evaluate the predictive performance via ten-fold cross validation. Results Five hundred nineteen patients who underwent transplantation from January 2015 to December 2018 were included. Forty-three severe pneumonia episodes (8.3%) occurred during hospitalization after surgery. Significant differences in the recipients' age, diabetes status, HBsAg level, operation time, reoperation, usage of anti-fungal drugs, preoperative albumin and immunoglobulin levels, preoperative pulmonary lesions, and delayed graft function, as well as donor age, were observed between patients with and without severe pneumonia (P<0.05). We screened eight important features correlated with severe pneumonia using the recursive feature elimination method and then constructed a predictive model based on these features. The top three features were preoperative pulmonary lesions, reoperation and recipient age (with importance scores of 0.194, 0.124 and 0.078, respectively). Among the machine learning algorithms described above, the Random Forest algorithm displayed better predictive performance, with a sensitivity of 0.67, specificity of 0.97, positive likelihood ratio of 22.33, negative likelihood ratio of 0.34, AUROC of 0.91, and AUPRC of 0.72. Conclusions The Random Forest model is potentially useful for predicting severe pneumonia in kidney transplant recipients. Recipients with a potential preoperative potential pulmonary infection, who are of older age and who require reoperation should be monitored carefully to prevent the occurrence of severe pneumonia.
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Affiliation(s)
- You Luo
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Zuofu Tang
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xiao Hu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Shuo Lu
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Bin Miao
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Songlin Hong
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Haiyun Bai
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Chen Sun
- Fane Data Technology Corporation, Tianjin 300384, China
| | - Jiang Qiu
- Department of Kidney Transplantation, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China
| | - Ning Na
- Department of Kidney Transplantation, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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3
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Abad CLR, Lahr BD, Razonable RR. Epidemiology and risk factors for infection after living donor liver transplantation. Liver Transpl 2017; 23:465-477. [PMID: 28176451 DOI: 10.1002/lt.24739] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/05/2017] [Accepted: 01/15/2017] [Indexed: 12/12/2022]
Abstract
The epidemiology of infections after living donor liver transplantation (LDLT) is limited. We aimed to study the epidemiology and risk factors of infections after LDLT. The medical records of 223 adult patients who underwent LDLT from January 1, 2000 to August 31, 2015 were reviewed for all infections occurring up to 1 year. We estimated the cumulative incidence of infection using the Kaplan-Meier product limit method. Risk factors were analyzed with time-dependent Cox regression modeling. The majority of patients were Caucasian (94.6%) and male (64.6%), and the median age at transplantation was 55 years. The most common indication for transplantation was primary sclerosing cholangitis (37.7%). A total of 122 patients developed an infection during the follow-up period (1-year cumulative event rate of 56%), with the majority (66%) of these occurring within 30 days after transplantation. Enterococcus sp. was the most frequent pathogen identified. Multivariate analysis showed that increased Model for End-Stage Liver Disease (MELD) score (per 10-point change: hazard ratio [HR], 1.59), history of recurrent infections prior to transplant (HR, 2.01), Roux-en-Y anastomosis (HR, 2.37), increased log-number of packed red blood cell transfusions (HR, 1.39), and biliary complications (HR, 4.26) were independently associated with a higher risk of infection. Infections occur commonly after LDLT, with most infections occurring early and being related to the hepatobiliary system. Higher MELD scores, the type of biliary anastomosis, presence of biliary complications, and prior pretransplant infections are independently associated with a higher risk for infections. Liver Transplantation 23 465-477 2017 AASLD.
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Affiliation(s)
- Cybele Lara R Abad
- Department of Medicine, Section of Infectious Diseases, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Brian D Lahr
- Division of Biomedical Statistics and Informatics
| | - Raymund R Razonable
- Department of Medicine, Division of Infectious Diseases, The William J. Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN
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4
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Balkan A, Balkan Y, Mete AÖ. A Case of Early detected Multidrug-resistant Acinetobacter baumannii Infection after Liver Transplantation. Euroasian J Hepatogastroenterol 2016; 6:170-172. [PMID: 29201752 PMCID: PMC5578588 DOI: 10.5005/jp-journals-10018-1192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 05/29/2016] [Indexed: 11/23/2022] Open
Abstract
Invasive bacterial infections have become the leading cause of morbidity and mortality among solid organ transplant recipients (SOTRs). Acinetobacter baumannii can cause a serious infection in SOTRs. Multidrug-resistant A. baumannii (MDR-Ab) represents a major problem in liver transplant recipients. Here, we presented a respiratory infection related to MDR-Ab pathogenesis in a patient who underwent liver transplantation due to acute hepatic failure. Accordingly, it has been emphasized that infections after the liver transplantation should be accomplished after due consideration of all relevant facts with a multidisciplinary approach.
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Affiliation(s)
- Ayhan Balkan
- Department of Gastroenterology, Gaziantep University, Gaziantep, Turkey
| | - Yasemin Balkan
- Department of Infectious Diseases and Clinical Microbiology Gaziantep University, Gaziantep, Turkey
| | - Ayse Özlem Mete
- Department of Infectious Diseases and Clinical Microbiology Gaziantep University, Gaziantep, Turkey
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5
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Tu Z, Xiang P, Xu X, Zhou L, Zhuang L, Wu J, Wang W, Zheng S. DCD liver transplant infection: experience from a single centre in China. Int J Clin Pract 2016; 70 Suppl 185:3-10. [PMID: 27197998 DOI: 10.1111/ijcp.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM The purpose of our study was to evaluate the incidence, timing, location and risk factors for bacterial and fungal infections after donation after cardiac death (DCD) liver transplant and clearly delineate any relationship between infection and survival in DCD liver transplant recipients. METHODS We retrospectively reviewed 257 consecutive patients undergoing DCD liver transplant between October 2010 and May 2015 at our centre. RESULTS A total of 133 patients (51.8%) developed at least one bacterial or fungal infection episode. The predominant infection site was the respiratory tract, followed by the blood stream. Most of the infections occurred within the first week after liver transplant (61.9%). A recipient respiratory support time greater than 7 days (p = 0.041), post-transplant hospital time greater than 24 days (p = 0.002) and renal failure after DCD liver transplant (p = 0.039) were independent predictors of bacterial and fungal infection. The area under the receiver operating characteristic (ROC) curve (AUC) of the transplant infection risk assessment model was 0.788. The 1- and 3-year survival rates for recipients without infection were significantly increased compared with recipients with infection (96.1% and 89.0% vs. 81.5% and 75.9%, p = 0.007). CONCLUSION This is the first study that offers detailed data revealing the timing and incidence of bacterial and fungal infection among adult DCD liver transplant recipients. Bacterial and fungal infection occurs at a high rate during the first week after DCD liver transplant, especially in patients with prolonged respiratory support time and renal failure, and infection is related to increased hospital stay.
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Affiliation(s)
- Z Tu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - P Xiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - X Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - L Zhou
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - L Zhuang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - J Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - W Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
| | - S Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou, China
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6
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Otlu B, Bayindir Y, Ozdemir F, Ince V, Cuglan S, Hopoglu M, Yakupogullari Y, Kizilkaya C, Kuzucu C, Isık B, Yilmaz S. Rapid Detection of Bloodstream Pathogens in Liver Transplantation Patients With FilmArray Multiplex Polymerase Chain Reaction Assays: Comparison With Conventional Methods. Transplant Proc 2016; 47:1926-32. [PMID: 26293075 DOI: 10.1016/j.transproceed.2015.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/10/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bloodstream infection (BSI) is an important concern in transplant patients. Early intervention with appropriate antimicrobial therapy is critical to better clinical outcome; however, there is significant delay when conventional identification methods are used. METHODS We aimed to determine the diagnostic performance of the FilmArray Blood Culture Identification Panel, a recently approved multiplex polymerase chain reaction assay detecting 24 BSI pathogens and 3 resistance genes, in comparison with the performances of conventional identification methods in liver transplant (LT) patients. A total of 52 defined sepsis episodes (signal-positive by blood culture systems) from 45 LT patients were prospectively studied. RESULTS The FilmArray successfully identified 37 of 39 (94.8%) bacterial and 3 of 3 (100%) yeast pathogens in a total of 42 samples with microbial growth, failing to detect only 2 of 39 (5.1%) bacterial pathogens that were not covered by the test panel. The FilmArray could also detect additional pathogens in 3 samples that had been reported as having monomicrobial growth, and it could detect Acinetobacter baumannii in 2 samples suspected of skin flora contamination. The remaining 8 blood cultures showing a positive signal but yielding no growth were also negative by this assay. Results of MecA, KPC, and VanA/B gene detection were in high accordance. The FilmArray produced results with significantly shorter turnaround times (1.33 versus 36.2, 23.6, and 19.5 h; P < .05) than standard identification methods, Vitek II, and Vitek MS, respectively. CONCLUSIONS This study showed that the FilmArray appeared as a reliable alternative diagnostic method with the potential to mitigate problems with protracted diagnosis of the BSI pathogens in LT patients.
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Affiliation(s)
- B Otlu
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey.
| | - Y Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - F Ozdemir
- Department of Surgery, Liver Transplantation Institute, Faculty of Medicine, Inönü University, Malatya, Turkey
| | - V Ince
- Department of Surgery, Liver Transplantation Institute, Faculty of Medicine, Inönü University, Malatya, Turkey
| | - S Cuglan
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - M Hopoglu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Y Yakupogullari
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - C Kizilkaya
- Department of Medical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - C Kuzucu
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - B Isık
- Department of Medical Microbiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - S Yilmaz
- Department of Surgery, Liver Transplantation Institute, Faculty of Medicine, Inönü University, Malatya, Turkey
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7
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Treatment Experience of Severe Abdominal Infection after Orthotopic Liver Transplantation. W INDIAN MED J 2015; 64:218-22. [PMID: 26426173 DOI: 10.7727/wimj.2014.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/05/2014] [Indexed: 11/18/2022]
Abstract
This study aims to investigate the causes and treatment experience of severe abdominal infection after orthotopic liver transplantation. Clinical data were retrospectively analysed in perioperative severe abdominal infection of 186 orthotopic liver transplantation cases from March 2004 to November 2011. Among the 186 patients, 16 cases had severe abdominal infection: five cases had bile duct anastomotic leakage-inducing massive hydrops and infection under liver interstice, 10 cases had extensive bleeding of surgical wound leading to massive haematocele and infection around the liver, and one case had postoperative lower oesophageal fistula leakage causing massive hydrops and infection under the left diaphragm. After definite diagnosis, 12 cases underwent surgery within three days, with no death. Among the four cases that underwent surgery three days after diagnosis, one case died of multiple-organ failure five days after abdominal cavity exploration, which was performed 21 days after liver transplantation. Severe abdominal infections after liver transplantation were the most common causes of death in perioperative liver transplantation. Comprehensive treatment with efficacious antibiotics, multiple-organ support, controlled surgical removal of the lesion, and adequate drainage establishment was the key to the entire treatment.
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8
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Gao F, Ye Q, Wan Q, Liu S, Zhou J. Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection. Ther Clin Risk Manag 2015. [PMID: 25848296 DOI: 10.2147/tcrm.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection. METHODS We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed. RESULTS Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm(3), and a platelet count of <50,000/mm(3), respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam. CONCLUSION The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.
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Affiliation(s)
- Fei Gao
- Infectious Disease Department of Henan Province People's Hospital, Zhengzhou, People's Republic of China
| | - Qifa Ye
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China ; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Qiquan Wan
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Shan Liu
- Adelphi University College of Nursing and Public Health, New York, NY, USA
| | - Jiandang Zhou
- Department of Clinical Laboratory of Microbiology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
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9
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Gao F, Ye Q, Wan Q, Liu S, Zhou J. Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection. Ther Clin Risk Manag 2015; 11:501-5. [PMID: 25848296 PMCID: PMC4381901 DOI: 10.2147/tcrm.s82251] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Drug-resistant Acinetobacter baumannii has become a major problem in liver transplant recipients. The aim of this study was to investigate the clinical presentation, distribution, and drug susceptibility characteristics in liver recipients with A. baumannii infection. Methods We retrospectively investigated 17 liver recipients who developed A. baumannii infection between January 1, 2007 and December 31, 2014. The distribution of A. baumannii and drug susceptibility characteristics were reviewed. Results Infectious complications due to A. baumannii appeared in 17 liver recipients, with a total of 24 episodes. Approximately 63% (15/24) of A. baumannii infections occurred within 2 weeks after transplantation. The most common source of infection was multiple culture-positive sites (35.3%, n=6), followed by the intra-abdominal/biliary tract (23.5%, n=4) and lung (23.5%, n=4). Eight patients (47.1%) had a body temperature of 38°C or higher at the onset of A. baumannii infection. Nine, seven, and 12 recipients had a serum creatinine level of >1.5 mg/dL, a white blood cell count of >15,000/mm3, and a platelet count of <50,000/mm3, respectively. There were five (29.4%) cases of septic shock and eight (47.1%) deaths. The rate of antibiotic resistance of A. baumannii to ten of 12 antibiotics investigated was more than 60%. Among the 24 infections caused by A. baumannii, 75% were carbapenem-resistant. The rods were relatively sensitive to tigecycline and cefoperazone-sulbactam. Conclusion The clinical manifestations of A. baumannii infection included a high body temperature, a decreased platelet count, an elevated white blood cell count, and onset in the early period after transplantation as well as high mortality. The antibiotic resistance rate of A. baumannii was extremely high. Prevention measures and combination antibiotic therapy are needed to improve the outcomes of liver recipients with A. baumannii infections.
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Affiliation(s)
- Fei Gao
- Infectious Disease Department of Henan Province People's Hospital, Zhengzhou, People's Republic of China
| | - Qifa Ye
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China ; Department of Transplant Surgery, Zhongnan Hospital, Wuhan University, Wuhan, People's Republic of China
| | - Qiquan Wan
- Department of Transplant Surgery, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Shan Liu
- Adelphi University College of Nursing and Public Health, New York, NY, USA
| | - Jiandang Zhou
- Department of Clinical Laboratory of Microbiology, Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
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10
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Kawaguchi Y, Sugawara Y, Akamatsu N, Kaneko J, Hamada T, Tanaka T, Ishizawa T, Tamura S, Aoki T, Sakamoto Y, Hasegawa K, Kokudo N. Impact of early reoperation following living-donor liver transplantation on graft survival. PLoS One 2014; 9:e109731. [PMID: 25396413 PMCID: PMC4232253 DOI: 10.1371/journal.pone.0109731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 09/04/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The reoperation rate remains high after liver transplantation and the impact of reoperation on graft and recipient outcome is unclear. The aim of our study is to evaluate the impact of early reoperation following living-donor liver transplantation (LDLT) on graft and recipient survival. METHODS Recipients that underwent LDLT (n = 111) at the University of Tokyo Hospital between January 2007 and December 2012 were divided into two groups, a reoperation group (n = 27) and a non-reoperation group (n = 84), and case-control study was conducted. RESULTS Early reoperation was performed in 27 recipients (24.3%). Mean time [standard deviation] from LDLT to reoperation was 10 [9.4] days. Female sex, Child-Pugh class C, Non-HCV etiology, fulminant hepatitis, and the amount of intraoperative fresh frozen plasma administered were identified as possibly predictive variables, among which females and the amount of FFP were identified as independent risk factors for early reoperation by multivariable analysis. The 3-, and 6- month graft survival rates were 88.9% (95%confidential intervals [CI], 70.7-96.4), and 85.2% (95%CI, 66.5-94.3), respectively, in the reoperation group (n = 27), and 95.2% (95%CI, 88.0-98.2), and 92.9% (95%CI, 85.0-96.8), respectively, in the non-reoperation group (n = 84) (the log-rank test, p = 0.31). The 12- and 36- month overall survival rates were 96.3% (95%CI, 77.9-99.5), and 88.3% (95%CI, 69.3-96.2), respectively, in the reoperation group, and 89.3% (95%CI, 80.7-94.3) and 88.0% (95%CI, 79.2-93.4), respectively, in the non-reoperation group (the log-rank test, p = 0.59). CONCLUSIONS Observed graft survival for the recipients who underwent reoperation was lower compared to those who did not undergo reoperation, though the result was not significantly different. Recipient overall survival with reoperation was comparable to that without reoperation. The present findings enhance the importance of vigilant surveillance for postoperative complication and surgical rescue at an early postoperative stage in the LDLT setting.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiko Sugawara
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomohiro Tanaka
- Organ Transplantation Service, University of Tokyo, Tokyo, Japan
| | - Takeaki Ishizawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Sumihito Tamura
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Taku Aoki
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Artificial Organ and Transplantation Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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11
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Freire M, Van Der Heijden I, do Prado G, Cavalcante L, Boszczowski I, Bonazzi P, Rossi F, Guimarães T, D'Albuquerque L, Costa S, Abdala E. Polymyxin use as a risk factor for colonization or infection with polymyxin-resistantAcinetobacter baumanniiafter liver transplantation. Transpl Infect Dis 2014; 16:369-78. [DOI: 10.1111/tid.12210] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/22/2013] [Accepted: 11/24/2013] [Indexed: 11/29/2022]
Affiliation(s)
- M.P. Freire
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - I.M. Van Der Heijden
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - G.V.B. do Prado
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - L.S. Cavalcante
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - I. Boszczowski
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - P.R. Bonazzi
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - F. Rossi
- Microbiology Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - T. Guimarães
- Infection Control Service; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - L.A.C. D'Albuquerque
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
| | - S.F. Costa
- Microbiology Research Laboratory; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
- Department of Infectious Diseases; University of São Paulo School of Medicine; São Paulo Brazil
| | - E. Abdala
- Liver and Gastrointestinal Transplant Division; Hospital das Clínicas; University of São Paulo School of Medicine; São Paulo Brazil
- Department of Infectious Diseases; University of São Paulo School of Medicine; São Paulo Brazil
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12
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Dorschner P, McElroy LM, Ison MG. Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis 2014; 16:171-87. [PMID: 24661423 DOI: 10.1111/tid.12203] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/24/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
Infections remain a common complication of solid organ transplantation. Early postoperative infections remain a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Although significant effort has been made to understand the epidemiology and risk factors for early nosocomial infections in other surgical populations, data in SOT recipients are limited. A literature review was performed to summarize the current understanding of pneumonia, urinary tract infection, surgical-site infection, bloodstream infection, and Clostridium difficult colitis, occurring within the first 30 days after transplantation.
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Affiliation(s)
- P Dorschner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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13
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Corrêa APA, Brahm MMT, Teixeira CDC, Ferreira SAL, Manfro RC, Lucena ADF, Echer IC. [Complications during the hospitalization of kidney transplant recipients]. Rev Gaucha Enferm 2013; 34:46-54. [PMID: 24344584 DOI: 10.1590/s1983-14472013000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the study was to identify the complications in patients that have received a renal transplant. A Historical cohort performed in a university hospital from January/2007 through January/2009 with a sample of 179 patients; data collected retrospectively from the medical history of patients and submitted to statistical analyses. Mean age of patients was 43 (SD=13.7) years, 114 (63.7%) men, 95 (65.1%) non smokers and 118(66.93%) received the graft from a deceased donor. The main complications were rejection 68 (32.1%) and infection 62 (29.2%). There was statistical significance between rejection and median days of hospital stay (p < 0.001); days of use of central venous catheter (p = 0.010) and smoking status (p = 0.008); infection and central venous catheter (p = 0.029); median days of hospital stay (p < 0.001) and time of use of urinary catheter (p = 0.009). It was concluded that it is important to reduce the days of hospital stay and permanence of catheters, which may be considered in the planning of nursing care.
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Abstract
OBJECTIVE Our aim was to determine perioperative risk factors for early bacterial infection after liver transplantation. METHODS Retrospectively examining medical records using Centers for Disease Control and Prevention (CDC) definitions to identify nosocomial infections, we analyzed data on 367 adult patients. RESULTS The incidence of infection was 37.3% (n = 137): namely, surgical site (n = 74; 20.2%) [corrected], blood stream (n = 64; 17.4%), pulmonary (n = 49; 13.4%), urinary system (n = 26; 7.1%). Significant risk factors within the first 30 days were as follows: deceased donor, Model for End-Stage Liver Disease (MELD) >20, albumin level <2.8 g/dL, intraoperative erythrocyte transfusion >6 U, intraoperative fresh frozen plasma >12 U, bilioenteric anastomosis, postoperative intensive care unit stay >6 days, and postoperative length of stay >21 days. Significant risk factors detected within the first 90 days were as follows: MELD >20, preoperative length of stay >7 days, reoperation, postoperative length of intensive care unit stay >6 days, and postoperative length of stay >21 days. Variability was observed in risk factors according to localization of infection. As a result, except for MELD, type of donor, and biliary anastomosis, the others are preventable factors for early bacterial infection. In addition, the same risk factors showed variability according to the site of infection.
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15
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[Liver transplantation with living donor : current aspects, perspectives and significance in Germany]. Chirurg 2013; 84:398-408. [PMID: 23595852 DOI: 10.1007/s00104-012-2414-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
More than 20 years ago living donor liver transplantation was introduced into clinical practice. Specifics of this method were developed initially for children and later on for adults particularly in regions where a liver transplantation program using deceased donors was not readily available. The most sensitive aspect of living donation, namely the danger to a healthy relative in order to perform the transplantation is immanent in the system and, thus, it is definitively a secondary option as compared to deceased organ donation. Following worldwide initial euphoria the numbers have markedly decreased in the western world since the start of the new millennium. In Asian countries in particular, much work has been done to optimize the procedure so that the donor safety and the outcome quality for the recipient have been impressively demonstrated in large patient populations. There is still a severe donor organ shortage and the option to allocate an optimal (partial) organ on an individual basis by living donation has given new impact to the discussion about a further rise in the profile of living donations here as well. The new version of the German transplantation legislation implemented in summer 2012 requires a number of conditions with respect to insurance for living donors. The current state and perspectives are presented here.
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