Liver Abcesses After Liver Transplantation

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Abstract

Introduction

Liver abscess after orthotopic liver transplantation (OLT) is a rare but life-threatening complication. Currently, with more accurate diagnostic techniques, enhanced treatments and improvements of intensive care, mortality has been reduced to 5-30%.

Materials and Methods

We perform a retrospective review of the patients who developed one or more liver abscess among a series of 984 patients who underwent OLT between January 2000 and December 2016. An abscess was defined as a radiological hepatic lesion, positive liver aspirates and/or concurrent blood cultures, and compatible clinical findings.

Results

Fourteen patients (1.5%) developed 18 episodes of liver abscesses, and the median time from OLT to the diagnosis of liver abscess was 39.7 months (range: 1.6-285). Main predisposing factors were biliary strictures in 11 patients, hepatic artery thrombosis (HAT) in 8, previous re-OLT in 3, choledocho-jejunostomy in 2, living-donor-liver-OLT in 2, deceased-donor-death in 1, split-liver in 1, and liver biopsy in 1. All patients were managed by intravenous antibiotics, and percutaneous drainage was performed in 10 patients, while 2 patients underwent re-OLT. The mortality rate related with liver abscesses was 21.4% (3 patients). The mean hospital stay was 30+19 days, and during a mean follow-up of 93+78 months three other patients died.

Discussion

The most important risk factors associated with hepatic abscess are HAT (etiology between 13.3%-66% of the cases), biliary stricture and use of donors after cardiac death. E. coli and Klebsiella pneumoniae are the most frequent organisms isolate. When antibiotic therapy and percutaneous drainage fail, a liver re-OLT must be considered in order to prevent the high mortality associated with this severe complication.

Conclusion

Liver abscesses must be managed with antibiotic therapy and percutaneous drainage, but when these conservative measures fail, a liver re-OLT must be performed.

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